我国医疗保险制度改革与发展

介绍了我国职工医疗保障制度的历史沿革，指出现行城镇职工基本医疗保险及新型农村合作医疗制度基本解决了广大城镇职工及农民的基本医疗需要，但有待进一步完善。城镇医药卫生体制配套改革(改革医院管理体制、改革医院补偿机制、改革药品流通体制)的深化，将有力地促进医药卫生事业的健康发展。促进社会经济与医药卫生事业协调发展，对提高全民族的健康素质具有重要意义，也是每一位卫生工作的职责。     

积极推进医疗保障制度改革促进经济和社会事业发展

近几年来,我省始终把城乡医疗保障制度改革作为建立社会主义市场经济体制的重要环节和深化卫生改革的龙头和突破口,积极推进城镇职工医疗保障制度改革试点工作,发展和完善农村合作医疗保健制度,取得了一定成效。目前,镇江市职工医疗保障制度改革试点两年运行平稳,初步建立了社会统筹医疗基金与个人医疗帐户相结合的职工医疗保险制度,为推进职工医疗保障制度改革积累了经验。与此同时,我省结合实施农村初级卫生保健,努力适应建立社会主义市场经济体制的新形势,不断改革和发展合作医疗制度,并逐步引进保险机制,探索和发展保健——风险型合作     

我国医疗保障制度改革中医院配套改革措施探讨

论述了医疗保障制度改革给医院带来的机遇与挑战,认为医院应采取调整结构,转换运行机制;完善补偿机制;加大宏观调控力度,制订和实施区域卫生规划等配套措施,来适应医疗保障制度的改革。     

深化职工医疗保障制度改革应处理好的问题

职工医疗保障制度改革是我国社会保障制度改革的重要组成部分,是建立和完善社会主义市场经济体制的必要条件,职工医疗保障制度改革直接关系到职工的切身利益,涉及各方面利益格局的调整,政策性强,随着1994年、1995年“两江”地区的试点,我国职工医疗保障制度改革的总体思路已经明确。然而,从“两江”试点来看,要深化乃至全面实行职工医疗保障制度改革,必须妥善解决以下几个问题。　　一、建立对医疗服务供应者的制约机制《中共中央国务院关于卫生改革与发展的决定》(以下简称《决定》)指出:“医疗机构和医务人员对于搞好职工医疗保障制度改革…     

抓住机遇 深化改革迎接医疗保险制度改革的挑战

建立职工医疗保险制度的基本原则之一,就是公平与效率相结合,职工享受的基本医疗保障待遇要与个人对社会的贡献适当挂钩;建立对医患双方的制约机制,促进医疗机构深化改革,加强内部管理,建立健全对医疗机构的合理补偿机制;推进区域卫生规划,逐步实现卫生资源优化配置与合理利用等。由这些基本原则可见,随着职工医疗保险制度的推行,对医院既是机遇,又是挑战。作为医院管理者,要把握住这一机遇,并以此为契机,深化内部改革,苦练内功,提高效率,使医院管理由粗放型向集约型转变,推进医院的建设和发展,或为医疗制度改革的推动者和受益者。     

深化上海市职工医疗保障制度改革的主要措施和步骤

介绍上海市职工医疗保障制度改革在实行医疗保险费用社会统筹、建立个人医疗帐户、完善老年医疗保障制度、调整企业医疗机构、推动多层次的医疗保障等方面的措施以及坚持由国家、单位和个人合理分担医疗费用,增加个人自我保障责任;实行社会化管理;理顺医院经营机制,提高医院服务质量的改革步骤。     

积极推进医疗保障制度改革促进经济和社会事业发展

近几年来,我省始终把城乡医疗保障制度改革作为建立社会主义市场经济体制的重要环节和深化卫生改革的突破口,积极推进城镇职工医疗保障制度改革试点工作,发展和完善农村合作医疗保健制度,取得了一定的成效。目前,镇江市职工医疗保障制度改革试点两年运行平稳,初步建立了社会统筹医疗基金与个人医疗账户相结合的职工医疗保险制度,为推进职工医疗保障制度改革积累了经验。根据国务院的部署,我省在总结镇江试点工作的基础上,又在苏州、无锡、南通、盐城4个城市扩大试点,扩大试点市的实施方案已经省政府批准,各项准备工作进展顺利,新的职工医疗保险制度于今年1月1日正式启动。与此同时,我省结合实施农村初级卫生保健,努力适应建立社会主义市场经济体制的新形势,不断改     

职工医疗保障制度改革四年来的回顾与展望

从建立新型的医疗保健制度,保障职工的基本医疗需求,遏制医疗费用过快增长的势头,职工个人帐户资金的积累,职工对新的医疗保障制度的满意度,深化医院内部改革,规范医疗行为等方面对镇江市职工医疗保健障制度改革的四年来的进展情况进行了回顾。     

浅谈医院如何适应医疗保障制度改革

铜陵市是安徽省第一个医疗保障制度改革试点市。医疗保障机制已初步确立并已投入运转．现就如何适应医疗保障制度改革谈一点粗浅看法，供同仁参考。一、医疗保障制度改革对医疗单位带来的影响（一）不利影响１、对医院经济收入的影响：改革后的职工医疗费用与个人挂钧，病人对自己的医疗费用增强了自我约束，职工就医减少，大处方、小病大治和特种检查也呈大幅度的下降趋势。加之社会保障局对医疗单位的用药、检查、收费加以控制，医院的经济收入将会明显减少．２、医患矛盾增加：医疗保障制度改革后，一方面迫使医院要对高档药品、大型医疗…     

浅议医改后医院新的医疗违规行为及对策

我国的医疗保障制度改革,确定了“低水平,广覆盖”的基本医疗保险制度,目的在于保障职工的基本医疗待遇。新的制度对医疗费用有了较强的控制措施,要求医院和医生昼理为病人提供优质低价的卫生服务,让有限的卫生费用使更大的人群受益。医疗保障制度的改变,使得医院的行为也会发生相应改变,在这种变化中,要谨防新的医疗违规行为的产生。     

Nutrition Measures for Managed Care Report Cards

Health plan “report cards,” that is, published summaries of health plan performance, are a new way to help consumers select a health plan on the basis of cost and quality. The Health Plan Employer Data and Information Set (HEDIS) includes a set of health plan performance measures, standardized definitions, and methods for data collection. HEDIS is used as the basis for many report card initiatives and is the preferred tool of the managed care industry for measuring health plan performance. Nevertheless, the current list of HEDIS performance measures omits many health services, including medical nutrition therapy. Nutrition measures have the potential for wide appeal among health care stakeholders (ie, payers, consumers, and providers). Four measures related to medical nutrition therapy are proposed for managed care report cards: staffing for nutrition services and medical nutrition therapy for high cholesterol level, gestational diabetes, and cardiovascular disease. Barriers to adopting medical nutrition therapy measures in HEDIS include the need to address technical issues before considering new measures and competition from other potential measures. Steps to create support for medical nutrition therapy measures in HEDIS should focus on influencing representatives of health plans and employers to include these measures. The involvement of registered dietitians in the dynamic process of health plan evaluation is an important extension of ongoing efforts for strategic positioning in the managed care market. J Am Diet Assoc. 1996; 96:374-380.     

Reliability and validity of medical outcome and patient satisfaction measures among injured workers in Washington state: A pretest

Several existing measures of medical outcomes and some newly constructed measures of patient satisfaction were tested for reliability and validity on a sample of 100 subjects who had suffered work-related injuries and illnesses in Washington State. Included in the measures of medical outcome were the SF-36 and the upper body mobility subscale of the Health Assessment Questionnaire. The newly constructed measures of patient satisfaction assessed areas such as satisfaction with the attending physician and with access to referrals. Also administered were assessments of job satisfaction, both prior to and since the injury, and a measure of chance health locus of control. The patient satisfaction and medical outcomes measures demonstrated good reliability and validity for use with this population. However, neither the measures of job satisfaction nor chance health locus of control were related to either patient satisfaction with medical care nor to medical outcomes. Am. J. Ind. Med. 31:427–434, 1997. © 1997 Wiley-Liss, Inc.     

安徽省天长市和福建省尤溪县县域医联体建设研究

本研究选取安徽省天长市和福建省尤溪县作为典型案例,从服务提供方式、筹资支付、治理规制、协作机制、资源共享等方面,对其县域医联体建设实践进行系统梳理和比较分析。研究发现,天长市和尤溪县医联体建设均比较重视政策措施的综合性、协同性和系统性,以医保支付方式为重点建立相容的激励约束机制,多措并举提升基层服务能力,但一些具体措施和资源整合程度有所差异,面临共性和个性问题。建议持续推动服务体系由"金字塔型"向"网络型"转变;在医联体内建立相容的激励约束机制;以提升基层服务能力为重点,强化人才、药品、信息等共享机制建设;针对特定问题,在措施执行层面不断调整完善、持续探索创新。     

精细化监管措施对规范医疗废物管理的效果研究

目的 评价精细化监管措施对规范医疗废物管理的效果.方法 选取某三级医院5个病区,实施医疗废物分类知识专项培训考核,贴实物图式标识,实地检查分类情况并现场反馈、指导等精细化监管措施.2019年3—5月为基线调查阶段,2020年11月—2021年1月为干预阶段,比较干预前后医务人员对医疗废物分类知识的知晓情况、分类正确率、...     

传染病专科医院应对新冠肺炎疫情的策略与实践探索

传染病医院作为各种传染病的救治基地,在突发公共卫生事件来临时,理应在疫情防控、救治病患和促进社会稳定方面发挥重要作用.阜阳市第二人民医院在抗击新冠肺炎疫情中借助以往传染病防控救治经验,积极开展发热门诊患者分类就诊,早期识别并重视重型、危重型患者的救治,实施普通型和重型病例临床路径管理,多措并举防控医院感染的发生,重视呼...     

矿难矿工医疗救治中医院感染管理的难点与体会 FREE

目的了解矿难矿工医疗救治工作中医院感染管理的特点。方法对矿难矿工施救的医院进行现场调查,根据现有条件提出可行的感染控制措施,同时观察控制措施的效果,并结合患者病情的发展及时调整感染控制措施。结果经各级医务人员的共同努力,被救矿难矿工没有发生医院感染,有效地保障了医疗救治的成功。结论实施的感染控制措施适当、有效。     

Organizational and Market Influences on Physician Performance on Patient Experience Measures

Objective. To examine the extent to which medical group and market factors are related to individual primary care physician (PCP) performance on patient experience measures. Data Sources. This study employs Clinician and Group CAHPS survey data (n=105,663) from 2,099 adult PCPs belonging to 34 diverse medical groups across California. Medical group directors were interviewed to assess the magnitude and nature of financial incentives directed at individual physicians and the adoption of patient experience improvement strategies. Primary care services area (PCSA) data were used to characterize the market environment of physician practices. Study Design. We used multilevel models to estimate the relationship between medical group and market factors and physician performance on each Clinician and Group CAHPS measure. Models statistically controlled for respondent characteristics and accounted for the clustering of respondents within physicians, physicians within medical groups, and medical groups within PCSAs using random effects. Principal Findings. Compared with physicians belonging to independent practice associations, physicians belonging to integrated medical groups had better performance on the communication ( p=.007) and care coordination ( p=.03) measures. Physicians belonging to medical groups with greater numbers of PCPs had better performance on all measures. The use of patient experience improvement strategies was not associated with performance. Greater emphasis on productivity and efficiency criteria in individual physician financial incentive formulae was associated with worse access to care ( p=.04). Physicians located in PCSAs with higher area‐level deprivation had worse performance on the access to care ( p=.04) and care coordination ( p<.001) measures. Conclusions. Physicians from integrated medical groups and groups with greater numbers of PCPs performed better on several patient experience measures, suggesting that organized care processes adopted by these groups may enhance patients' experiences. Physicians practicing in markets with high concentrations of vulnerable populations may be disadvantaged by constraints that affect performance. Future studies should clarify the extent to which performance deficits associated with area‐level deprivation are modifiable.     

积极适应市场经济 加强军队医院建设

国家经济体制的转变和医疗保险制度的改革,对军队医院产生了深刻的影响。军队医院目前面临的形势是:(1)经费严重短缺,供需矛盾非常突出;(2)国家公费医疗保障制度改革带来巨大冲击;(3)内部管理机制亟待改进。要积极适应市场经济,军队医院应采取以下措施:(1)挖掘自身潜力,走内涵建设之路;(2)改革现行军队公费医疗保险制度;(3)主动与国家公费医疗保险制度改革接轨。     

Changing health care quality paradigms: The rise of clinical guidelines and quality measures in American medicine

Clinical guidelines and quality measures are important new paradigms for conceptualizing and managing quality in the United States. Researchers have proposed that professional elites—including members of academic medicine—were an important cause of the shift to guidelines and measures. This paper draws on content analysis of abstracts focused on quality in major American medical journals between 1975 and 2009 to empirically assess whether and how paradigms for managing quality changed in academic medicine. The content analysis shows that guidelines- and measures-based approaches to quality increased in prominence. Individual expertise-based approaches to quality, however, remain important. Concurrent with changing paradigms in academic medicine, there was a reorientation of policy toward increased use of guidelines and measures the late 1980s and early 1990s in the United States. This policy reorientation was informed by earlier work by medical researchers proposing new approaches to quality. The policy reorientation was followed by an increase in the prominence of guidelines and measures in medical research.     

我国医疗机构的主要问题及其对策

指出我国医疗机构目前存在的主要问题，即医疗服务供求关系失衡，效率低下；医疗费用迅猛上涨，服务成本不断扩大；行业和内部管理松懈，社会反响强烈。在分析其产生原因的基础上提出相应的对策建议，即改革医疗机构管理体制；推行医药分业，实行医疗机构分类管理；实行从医资格认定管理，医疗机构用人实行合同聘任制。