Health care reforms in the French hospital system

The French health care system, like other health care systems, entered the 1990s in a state of flux. During the 1980s, attempts to curb health care expenditure had a limited impact with the liberal and pluralist values of the health system undermining reform strategies. In 1991 the French government introduced a new hospital reform which had four main strands: rationalizing public and private health care provision; introducing a medical logic into the hospital service; increasing hospital autonomy and strengthening participation and involvement in the hospital system. However, these reforms left untouched the financing of the health service. Consequently there remains a need for a more fundamental reform of the management and financing of the French health care system.     

Policy trends and reforms in the German DRG-based hospital payment system

A central structural point in all DRG-based hospital payment systems is the conversion of relative weights into actual payments. In this context policy makers need to address (amongst other things) (a) how the price level of DRG-payments from one period to the following period is changed and (b) whether and how hospital payments based on DRGs are to be differentiated beyond patient characteristics, e.g. by organizational, regional or state-level factors. Both policy problems can be and in international comparison often are empirically addressed. In Germany relative weights are derived from a highly sophisticated empirical cost calculation, whereas the annual changes of DRG-based payments (base rates) as well as the differentiation of DRG-based hospital payments beyond patient characteristics are not empirically addressed. Rather a complex set of regulations and quasi-market negotiations are applied. There were over the last decade also timid attempts to foster the use of empirical data to address these points. However, these reforms failed to increase the fairness, transparency and rationality of the mechanism to convert relative weights into actual DRG-based hospital payments.     

我国公立医院医疗服务支付制度改革进展及存在问题探讨

在梳理我国公立医院医疗服务支付制度历史沿革、主要改革做法及成效的基础上,重点分析改革中存在的支付标准不够科学合理、支付制度改革缺乏系统性和联动性、医务人员参与改革的积极性未能充分调动等问题及深层次的制度原因,进而提出推进我国公立医院医疗服务支付制度改革的政策建议,包括谈判确定支付标准,创新支付方式改革的“组合拳”,逐步推进支付制度改革系统工程,建立支付制度改革激励作用的传动机制.     

医院运行机制改革的实践

近几年来,特别是1999年以来,潍坊市坚持以深化医院经济体制改革为突破口,不断加大综合配套改革力度,推出了一系列深化医院改革的新举措。市政府出台了《潍坊市医院改革试点意见》,市卫生局制定了有关配套措施,各项改革措施到位,整个改革进展顺利,全市卫生事业呈现出良好的发展势头。我们的主要做法是: 1 建立医药费用控制机制,完善医院补偿机制 医药费用增长过快已是近几年群众关注的焦点、热点问题,我们虽然运用行政手段,采取措施控制医药费用过快增长,但是,由于缺乏经济手段和机制约束,医药费用增长过快     

浏阳集里卫生院改革启示

改革开放以来,我国农村经济体制和社会环境发生了很大变化。农村实行家庭联产承包责任制、发展市场经济和小城镇建设以及实施西部大开发等,这些对传统的农村卫生服务体系产生了巨大影响。农民医疗保健需求也呈现出多层次和多样化,如何结合本地实际,探索出一种既能适应市场经济体制,又能满足广大农民基本医疗保健需求的健康保障新形式,已成为一项十分重要的任务。近年来,湖南省浏阳市集里卫生院在生存与发展、改革与创新中,走出了一条专科带动、以乡村卫生组织一体化管理和农村社区卫生服务的发展道路,以开拓性精神探索农村卫生院的改革与发展,赢得了社会效益与经济效益的同步增长。1 卫生院改革的前景     

深化医院改革 促进科研工作

通过深化改革，在提高医疗水平的同时，促进了科研工作的开展，该院的是具体做法是：加大科研经费的投入，改善科研支撑条件，注得人才培养；出台激励政策。     

The impact of hospital management reforms on absenteeism in Costa Rica

The reduction of high levels of absenteeism among health care workers was one the objectives of the reforms undertaken to improve public hospital performance during the 1990s in Costa Rica. This paper attempts to assess the impact of changes in reimbursement methods and organizational reform on absence rates among health care personnel in Costa Rican public hospitals for the period 1995-2001. Our results show the reforms to have had a negative impact on absenteeism, which increased throughout the considered period. Results further indicate that the policy of not substituting absentee workers, which was introduced through the reforms, did not work as expected in a permissive environment in which peer pressure mechanisms were lacking. In addition, the explicit incentives for workers included in the reforms were retained and used at facility level. There is a pressing need in the future for control and disciplinary mechanisms for health care personnel and for the introduction of absence rates as an explicit goal to be monitored and evaluated.     

医院管理改革重在改革医院的运行机制

探讨医院管理改革问题.通过分析目前医院管理中存在的主要问题,并结合总结本院管理改革经验,提出医院管理改革重在改革医院的管理机制和运行机制.