浅谈社区卫生服务机构收支两条线管理

社区卫生服务机构收支两条线管理源自于但并非完全等同于传统的收支两条线管理,它本质上是一种资金管理方式,但却突破了单纯意义上财务管理的概念.而是一种综合性制度设计.在社区卫生服务机构实施收支两条线管理,是政府承担发展社区卫生服务的责任的体现,这一制度作用于社区卫生服务机构内部的利益链环节,进而根除以药养医问题,促使社区卫生服务机构体现公益性.各地应建立在正确认识这一制度,并在基本条件具备的前提下开展试点,以便这一制度能规范实施、顺利推广,并取得实效.     

典型地区社区卫生服务机构收支两条线管理模式的比较分析

通过分析典型地区社区卫生服务机构收支两条线管理模式,其共同特点是实行全额预算管理,以区财政为主实行多级财政筹资,收支两条线管理实施过程中收入和支出的内容基本相同;不同点包括收支两条线管理的方式、社区卫生服务机构总收入中财政投入标准和支出管理等三个方面的差异。通过分析不同收支两条线管理模式的优缺点．提出社区卫生服务机构实施收支两条线管理并没有绝对的最优和最差做法,各地在实践中,既要分析不同模式的优缺点,也要结合本地实际,总结已有的经验和教训,以便顺利开展社区卫生服务机构收支两条线管理试点。     

社区卫生服务机构收支两条线管理实施效果分析

文章以现场调研所收集的定性、定量数据为基础,对经济状况基本相当,但实行和未实行社区卫生服务机构收支两条线管理的两个地区其社区卫生服务机构的筹资结构、服务提供、次均门诊费用、社区人群满意度及社区医务人员满意度情况进行对比分析.得出的结论是:实行收支两条线管理地区社区卫生服务机构较好地落实了基本医疗和公共卫生服务、就诊人群医疗费用负担减轻、社区人群及社区医务人员满意度较高,此外,社区卫生服务机构并没有出现效率降低的情况,而政府也完全有能力负担社区卫生服务机构实行收支两条线管理.     

北京市社区卫生服务实施效果及建议

收支两条线管理是我国针对社区卫生服务机构实行的一项新财务管理制度,北京市是较早推行收支两条线管理的试点城市之一.通过对北京市社区卫生服务工作现状、财政资金投入以及社区卫生服务绩效结果进行分析,了解北京市收支两条线管理政策的实施效果及其影响,并对北京市社区卫生服务机构的发展提供政策性建议,以期完善以社区卫生服务为基础的新型城市医疗卫生服务体系.     

社区卫生服务机构实施收支两条线管理的现状及对策

经过多年的探索,社区卫生服务机构实行收支两条线管理的成效显著。社区卫生服务机构的公共卫生服务得到有效落实,无论是社区医务人员还是社区居民满意度都有较大提高。然而,社区卫生服务机构实行收支两条线管理也遇到了许多问题。文章通过对社区卫生服务机构实施收支两条线管理的现状、困难进行分析,就存在的新问题提出合理性建议与对策,总结实施收支两条线管理的必要性,在新医改攻坚阶段从而更好地完善政府投入、收支运行、考核分配等管理体制与运行机制,进一步保障社区卫生服务机构的正常运行,充分发挥收支两条线管理在社区卫生综合改革中的核心作用。     

北京社区卫生服务机构员工对收支两条线管理的认知评价

[目的]了解北京社区卫生服务机构员工对收支两条线管理的认知评价情况.[方法]采取问卷调查的方法,调查北京社区卫生服务机构员工对收支两条线管理的认知评价情况,进行相应的统计学分析.[结果]201名社区卫生服务工作人员中78.1%认为在社区卫生服务机构实施收支两条线可以提高员工的工作积极性,83.1%希望实行收支两条线;所在机构已实施收支两条线管理的人员对该改革措施的反馈结果不乐观.[结论]北京市社区卫生工作人员对收支两条线管理的实施表示支持,实施意愿较高,但是应对配套的绩效考核评价体系进行深入的研究和论证,从而有效地提高社区医务人员的工作积极性.     

社区卫生服务机构收支两条线管理的实施路径

社区卫生服务机构实施收支两条线管理包括两个阶段:一是前期准备工作,包括建立组织保障体系和技术支撑体系,政府、卫生行政部门及社区卫生服务机构分别做好相应准备工作;二是具体实施过程,其关键环节包括收支预算、收支的监控与管理、配套制度的实施.最后提出,各地在试点过程中需要把握这些规律性要点,并要结合实际进行方案调整,以确保收支两条线管理稳步推进,并产生积极效果.     

成都武侯区社区卫生服务机构实施收支两条线管理的关键技术措施分析

[目的]分析成都市武侯区社区卫生服务机构实施收支两条线管理的关键技术措施,为其他地区推广收支两条线管理模式提供借鉴. [方法]收集武侯区收支两条线改革的操作性文件、访谈该区社区卫生服务机构管理者和问卷调查社区卫生服务机构职工. [结果]对技术措施的重要性排序,武侯区社区卫生服务机构管理者认为最重要的是机构财务独立、财政预算管理、人事编制管理、绩效考核制度和备用金制度;职工认为最重要的是人员经费支出制度、结余管理制度、收支预算制度、绩效考核制度和备用金制度. [结论]武侯区收支两条线管理的关键技术措施为:社区卫生服务机构与举办机构脱钩,实现财务独立;收入全额上缴,支出纳入财政预算实行集中管理、统一结算;人事问题上定编定岗不定人,职工工资分为岗位工资和绩效工资两部分;加强机构和个人的绩效考核;实行运行经费备用金制度.     

收支两条线管理对社区卫生健康管理标准服务量变化的影响

目的 探讨收支两条线政策对社区卫生服务机构健康管理标准服务量的影响.方法 对北京市执行收支两条线管理的137家社区卫生服务机构2006至2009年健康管理数据作回顾性研究,使用SPSS 13.0软件对城区和郊区社区卫生服务机构收支两条线管理前后的健康管理年标准服务量均数作配对t检验.结果 收支两条线管理前后城区和郊区社区卫生服务机构健康管理标准服务总量分别由1081965.53和157492.23减少为971793.98和149305.25（P〉0.05）,其中城区机构医疗卫生标准服务量比例由59.94%减少至52.14%（P〈0.05）、院外服务与管理标准服务量比例由13.50%增加至18.88%（P〈0.05）.城区机构以妇女保健、慢性病新建档案、健康宣传、卫生信息管理标准工作量的明显增加和住院标准工作量的明显减少为主（P〈0.05）;郊区机构则以临时观察患者和地方病防治标准工作量的增加为主（P〈0.05）.结论 收支两条线管理可减少社区卫生服务机构医疗服务工作比例,增加健康管理与院外服务工作比例,适应了健康管理的工作需求和发展趋势,城区好于郊区,但相关配套政策还有待进一步完善.     

社区卫生服务机构人员对实施"收支两条线"改革满意程度的分析

目的了解杭州市社区卫生服务机构负责人和医务人员对实施"收支两条线"的满意程度.方法采用调查问卷的形式对社区卫生服务机构负责人和医务人员进行调查分析.结果机构负责人和医务人员对实施"收支两条线"总体满意程度分别为58.3%和39.8%.结论社区卫生服务机构人员对实施"收支两条线"总体上是满意的,但还需进一步完善"收支两条线"制度.     

Survey of ethylenethiourea (ETU) in ethylenebis(dithiocarbamate) (EBDC) fungicides

Ethylenethiourea (ETU) has been recognized as a compound with adverse toxicological properties. It may occur in ethylenebis(dithiocarbamate) (EBDC) fungicides as a by-product and/or a degradation product. Restrictions have been issued by the Italian Health Authority to keep the level of ETU in EBDC formulations under 0.5% (on an EBDC technical product basis). A survey was carried out on 85 samples of commercial formulations from the Italian market to verify compliance with the above limitation. ETU was extracted by methanol and determined by gas chromatography with a flame ionization detector. Three of the 85 samples (3.5%) exceeded the limit of 0.5% established by the Italian legislation for ETU.     

Diagnostic image (5) (Ileum pathology)

In a 28-year-old woman Crohn's disease was diagnosed. She had drug treatment but the situation deteriorated and ileocoecal resection was carried out. In the surgical specimen the diagnosis was confirmed.     

Sorption of Phosphate and Cr(VI) by Fe(III) and Cr(III) Hydroxides

Understanding the chemical behavior and interactions of Cr(VI) (e.g., HCrO₄ ⁻) and other anions, such as orthophosphate (P) with insoluble metal hydroxides (i.e., Cr[III] and Fe[III]) in disposal landfills or in chromite ore processing residue (CORP)–enriched soil is very important in predicting the movement and the fate of Cr(VI). This study evaluates the sorption behavior of P and Cr(VI) by Fe(III) (i.e., ferrihydrite), Cr(III) (i.e., Cr[OH]₃), and coprecipitated Fe(III)/Cr(III) hydroxides. These metal hydroxide sorbents were synthesized, and sorption of P and Cr(VI) were conducted at different pH using a batch technology. Our results show that P and Cr(VI) sorption by metal hydroxides decreased with increasing suspension pH. Greater decrease in P sorption was observed when Cr(III) was present in the structures of hydroxides. Following the sorption of low concentration of P (i.e., 0.5 mM), the sorption of subsequently added Cr(VI) by hydroxides was less influenced. However, Cr(VI) sorption was greatly inhibited when high concentration of P (i.e., 10 mM) prereacted with hydroxides, particularly in Fe(III) hydroxide system. Results also indicated that high concentration of Cr(VI) (10 mM) could dissolve Cr(III) hydroxide at pH 3 and reprecipitate as an amorphous form of Cr(VI) and Cr(III) compound at pH about 6.5. Although coprecipitation of Cr(VI) with Cr(III) can inhibit Cr(VI) movement through soil profiles, the inhibition seems to be low due to the gradual release of Cr(VI) with increasing pH. Received: 16 April 2002/Accepted: 29 October 2002     

Crusted (Norwegian) scabies in Dakar (Senegal)

Between January 1993 and June 1997, 30 patients with crusted scabies were seen at the dermatological clinic in Dakar (Senegal). Seventeen of these patients were male and 13 were female. Six were children aged 5 to 15 years and 24 were adults aged 18 to 70 years. Diagnosis of crusted scabies was straightforward because this condition, which was rare in Dakar before 1990, has become much more common and is now familiar to Senegalese dermatologists. The infection presented as an extensive scaly or crusted eruption with symmetrical lesions affecting the hands, feet, knees, elbows and ears in particular. Scalp involvement was reported in 25 patients. Erythrodermia was present in 4 cases and pachyonychia in 4 cases. Twenty-seven of the 30 patients had moderate or severe pruritus, whereas an absence of pruritus is regarded as a classical characteristic of crusted scabies. Diagnosis was readily confirmed by examination of hyperkeratotic material under the microscope: numerous mites and eggs were present. The two most common etiological factors were auto-immune diseases (6 cases, 4 of whom were receiving no steroid or other immunosuppressive treatment at the time of onset of crusted scabies) and malnutrition (5 of the 6 children in the study). The other associated conditions identified were: physical debilitation (4 cases), HIV infection (3), mental disability-Down's syndrome (3) and long term use of topical steroids for artificial depigmentation (2). Two patients were immunocompetent and 5 patients died shortly after diagnosis, before any underlying conditions could be identified. Seven patients were cured with benzyl benzoate. Seven others, all adults, received a single oral dose of ivermectin (200 mg/kg) and topical kerolytic drugs. Ivermectin was ineffective in 1 case, and an improvement was observed in another case, although a complete cure was achieved only after a second dose. The other patients were all cured and showed no signs of scabies one month after ivermectin treatment. A recurrence was observed in 3 patients a few months later however, suggesting that these patients were reinfected. No side effects were reported in any of the patients treated with ivermectin.