上海市公立医疗机构特需医疗服务现况及对策建议

发达国家一般对高端医疗有着明确的提供主体和市场划分[1-4].基本医疗服务大都由公立医疗机构或非营利性医疗机构提供;高端服务主要由营利性医疗机构提供,但公立医疗机构或非营利性医疗机构也有涉及,只是规模上受到严格控制,例如澳大利亚、新加坡等[5-6].     

非营利性医疗机构医疗服务分档定价评估指标体系研究

目的建立非营利性医疗机构医疗服务分档评估指标体系。方法采用专家咨询法筛选医疗服务分档评估指标,建立非营利性医疗机构医疗服务分档评估指标体系,并对该指标体系进行实证研究。结果研制出包括医疗服务基础质量、医疗服务环节质量和医疗服务终末质量三个方面共21个指标的非营利性医疗机构医疗服务分档评估指标体系。结论医疗服务分档评估指标体系的建立基本达到了研究的要求,实证结果与课题前期研究设想基本吻合,指标体系对推动医疗服务分档定价评价理论具有一定的理论指导意义。     

社会资本与民营非营利性医疗机构的发展空间

社会资本指的是社会组织的特征,如信任、规范和网络,它是无形的,可以通过促进合作行动提高社会效率。随着我国医疗改革的深入,由民间资本创立,旨在提供社会公共卫生服务的非营利性医疗机构将作为国有非营利性与民营营利性医疗机构的有效补充在医疗市场发挥作用。树立民营非营利性医疗机构的良好社会公众形象并获得群众大力支持和帮助,赢得慈善机构捐资、争取企业或个人赞助等均是非营利性医疗机构创造并利用社会资本,赢得生存和发展空间的关键。     

经济学视野下的医疗服务产品定性和对供方选择的影响

从经济学角度,分析了某些医疗服务本质上属于私人产品,应当由市场提供。并建议为抵消医疗服务产品的不确定性和市场信息不对称所导致的契约失灵的影响,社会资本注入医疗服务市场,应该以举办非营利性医疗机构为优先考虑。     

医疗价格控制政策对医疗供求结果的影响及评价

按照新的卫生改革政策 ,国家对营利性医院提供的医疗服务将实行市场调节价 ,而对非营利性医院提供的医疗服务将实行政府指导价 ,非营利性医疗机构按照价格主管部门制定的基准价并在其浮动幅度范围内确定本单位的实际医疗服务价格。这意味着非营利性医院将以基准价、价格上限、价格下限参与医疗机构之间的竞争。一项新的价格政策的出台和逐步实施 ,对医疗供求关系将产生什么样的结果 ,必须要做到心中有数 ,以利纵驾全局 ,及时调控 ,深化和完善卫生改革。现笔者对非营利性医院的价格控制政策进行经济学的分析与评价。1　医疗价格上限对医疗服…     

医疗卫生机构的税收政策

对非营利性医疗机构有哪些税收政策？对非营利性医疗机构按照国家规定的价格取得的医疗服务收入 ,免征各项税收。不按照国家规定价格取得的医疗服务收入不得享受这项政策。对非营利性医疗机构从事非医疗服务取得的收入 ,如租赁收入、财产转让收入、培训收入、对外投资收入等 ,应按规定征收各项税收。非营利性医疗机构将取得的非医疗服务收入直接用于改善医疗卫生服务条件的部分 ,经税务部门审核批准 ,可抵扣其应纳税所得额 ,就其余额征收企业所得税。对非营利性医疗机构自产自用的制剂 ,免征增值税。非营利性医疗机构的药房分离为独立的药品…     

关于广东调整医疗服务价格的政策分析

2006年6月,广东省出台了新的《医疗服务价格规范和调整方案》,该方案明确规定不再对非营利性医疗机构医疗服务定价,转而制定价格上限,实行政府指导价;营利性医疗机构实行市场调节价.它的出台标志着医疗服务由政府定价的计划经济政策在广东省终结,从而具有重大意义.     

福建省城镇医疗机构实行新的分类管理制度

福建省卫生厅、财政厅和计委近日联合发出通知 ,对全省城镇医疗机构的分类管理作出规定。医疗机构经分类核定后 ,将重新核发《医疗机构执业许可证》 ,并注明非营利性或营利性。通知要求各地依据当地经济和社会发展水平、群众医疗服务需求和医疗卫生资源 ,在区域卫生规划指导下 ,按照自愿选择和政府核定相结合的原则确定现有医疗机构的分类。非营利性医疗机构在医疗服务体系中占主体和主导地位。政府不举办营利性医疗机构。非营利性医疗机构不以营利为目的 ,其收入只能用于弥补医疗服务成本和自身的发展 ,执行政府规定的医疗服务指导价格 ,享…     

医疗价格的竞争谋略

国家计委、卫生部下发的《关于改革医疗服务价格管理的意见》明确指出 :“对非营利性医疗机构提供的医疗服务实行政府指导价 ,医疗机构按照价格主管部门制定的基准价并在其浮动幅度范围内确定本单位的实际医疗服务价格。对营利性医疗机构提供的医疗服务实行市场调节价 ,医疗机构根据实际服务成本和市场供求情况自主制定价格。”以上改革政策的推出 ,客观上促进了医疗行业的价格竞争。医疗服务价格与服务态度、服务质量、服务环境等一样 ,是重要的竞争因素 ,同时也是指导医疗资源配置的信号 ,价格竞争的正确与否 ,涉及到政治、经济、法律等方…     

医院分类管理带来的挑战和机遇

医疗机构的改革同其它行业的改革一样 ,经历了十几年的探索和实践。最近 ,国家出台了新的医疗机构改革政策 ,允许营利性医疗机构进入医疗市场。本文就这一政策给公立医疗机构改革带来的挑战和机遇作一些探讨 ,与同行商榷。一、营利性医疗机构准入带来的挑战和机遇医疗机构分类管理制度规定 :将医疗机构分为非营利性和营利性两类进行管理。非营利性医疗机构在医疗体系中占主导地位 ,享受相应的税收优惠政策 ,其中政府办的非营利性医疗机构由同级财政给予补助。营利性医疗机构是通过医疗市场的竞争 ,在满足社会医疗需求的同时获取经营利润 ;其…     

我国医疗卫生产业结构调整中存在的问题和期望

卫生产业包含医疗、预防、保健、康复、教学、科研等子系统,服务类型众多,结构复杂.伴随着市场经济体制在我国的逐步确立,我国医疗卫生产业也在不断发展和变化组合,期间浮现出许多问题.该文总结分析了当前医疗卫生产业结构中存在的若干关键问题,明确了这些问题对医疗卫生产业有序发展的危害,阐述了作者对卫生产业发展所持的期望和蓝图构想.     

Developing evidence-based ethical policies on the migration of health workers: conceptual and practical challenges

It is estimated that in 2000 almost 175 million people, or 2.9% of the world's population, were living outside their country of birth, compared to 100 million, or 1.8% of the total population, in 1995. As the global labour market strengthens, it is increasingly highly skilled professionals who are migrating. Medical practitioners and nurses represent a small proportion of highly skilled workers who migrate, but the loss of health human resources for developing countries can mean that the capacity of the health system to deliver health care equitably is compromised. However, data to support claims on both the extent and the impact of migration in developing countries is patchy and often anecdotal, based on limited databases with highly inconsistent categories of education and skills.     

Ivan Illich and the pursuit of health

Fifty years ago, when medicine had relatively few effective treatments to offer, its value was unquestioned. Twenty-five years ago clinicians had become concerned that treatment could sometimes do harm and McKeown published epidemiological evidence claiming that medicine did little good. This state of affairs was used by Illich to bolster his crusade against technology in general. Today it is clear that medicine now makes a large contribution to health. But doubts still exist and alternative pathways to health are continually exhorted. Large-scale efforts at behavioural modification, encouraging the adoption of healthier lifestyles, have been largely unsuccessful. Social activists now argue that funds should be diverted from medical care to social programmes that, they claim, might contribute more to health. While it is true that health is strongly associated with socio-economic status (income, education and occupation), there is little sense of how best to reallocate scarce resources so as to improve the health impact of social and economic programmes. Social reform is not a substitute for medical care. Rather, our social environment is a second, important but quite separate, determinant of health and well-being.     

Health,Risk and Society: six years on

In this editorial the Founding Editor of Health, Risk and Society reflects on the aims of the journal and the extent to which they have been achieved in first five volumes of the journal. The editorial looks forward to the opportunities offered by the expansion of the journal to four issues per year and the ways in which aims of the journal can be developed to include such issues as risk production and construction and to provide more sophisticate theoretical insights into the relationship between risk, health and society.     

Introduction of a vaccination database: experience with an integration project

This paper describes an actualization program of the vaccination profile in a medium-size city, through the introduction of a Database that allows the consolidation of information from each child in relation to the vaccination coverage in a nominal, fast and unified registration. The final result revealed that the effective involvement of all the social and professional segments and participating institutions are of prime importance in obtaining reliable data and in turning this proposal into one of the health vigilance strategies.     

The globalization of public health: the first 100 years of international health diplomacy

Global threats to public health in the 19th century sparked the development of international health diplomacy. Many international regimes on public health issues were created between the mid-19th and mid-20th centuries. The present article analyses the global risks in this field and the international legal responses to them between 1851 and 1951, and explores the lessons from the first century of international health diplomacy of relevance to contemporary efforts to deal with the globalization of public health.     

社区卫生服务机构绩效评价实践探讨

探讨基于战略目标管理理论的社区卫生服务机构绩效评价实践,创新绩效评价思路。绩效评价机制调动了社区卫生服务机构的积极性,促进了机构目标管理和运行效率,服务数量、服务质量和满意度持续改善,促进了社区卫生服务工作协调、健康、可持续发展。     

Defining Aggregations of the Poor for Community Health Center Location

Socioeconomic indexes based on multiple criteria of education, employment, and income are constructed and applied to Los Angeles County census data closely analyzed by area. Areas are classified by socioeconomic level of their residents, and large aggregations of the indigent and other groups are identified and delineated. Minimal assumptions about the function of community health centers permit estimation of their required number and best location to serve socioeconomic groups unable to obtain adequate health care privately.     

医院感染管理科在应对突发公共卫生事件中的作用

医院感染管理科作为医院应对突发公共卫生事件(主要是传染病暴发)的重要职能科室．应当根据传染病的流行趋势,做好监测、报告、预警、咨询、预防、控制、指导及督查等职能工作．完善落实各项医院感染管理工作制度,加强学科建设和基本设施建设．推动医院感染管理学科及感染控制工作的进一步发展．提高医院应对突发公共卫生事件的能力和医疗质量．确保医疗安全。