“四一三”医疗保险模式可行性研究

“四一三”医疗保险模式是在客观总结国务院“两江”医改试点经验、教训的基础上,吸取武汉市商业职工医院“保险医疗”和美国的HMO等多种医保模式的优点,提出的一种医疗保险新模式。后又经几年实践,提出了与“四一三”医保模式相适应的“大小多少”医保配套措施。1“四一三”模式的概念与意义“四一三”医保模式是“四定一自由三方付费”医疗保险模式的简称。1.1四定定就诊医院、定医保费用、定医保质量、定医院定点人数规模(即由医保机构根据参保人的意愿,将医保费用按人头包干给具备一定条件的医院,费用超支不补,结余归医院;并由医保机…     

上地医院“惠民模式”，想说爱它不容易

2007年1月15日，《新京报》发表了《上地医院“惠民模式”复制猜想》的章。尽管是一家位置偏僻、规模不大的二级综合医院，但上地医院却因作为北京首家完全由政府出资举办的非营利性医院，于2005年12月在海淀区正式挂牌而受到社会舆论的广泛关注。而这篇章则因披露了“运行一年为患节省二千万，背后则是政府三千万差额补贴”的内部消息，再次吸引了受众的目光。[第一段]     

医院公有制“国有民营”模式的可行性研究

医院实行“国有民营”的内涵是公有制医院在保持所有制不变，医院仍为国家所有的情况下，建立国有医院和政府之间的专业投股机构或医院管理公司，避免政府直接提供卫生保健服务，医院则自主经营，实现所有权与经营权分离。这种模式的特点是保持公有制不变，通过非政府组织实现国家所有权，而不是实行私有化。作者借鉴国外经验，参照企业改革走过的路。总结回顾过去医院改革的经验和教训，提出公立医院“国有民营”的模式，并进行粗浅的可行性分析，以供同行共同研究。     

军队中小型医院“机场式”护理模式探讨

门诊患者少、空置病床多困扰着中小医院在求生存和控成本中挣扎。大医院一个三级或四级亚专业需要两个以上护理病区，而中小医院一个病区收治两个以上专业还常常空床，医务人员感觉“吃不饱”、“活不好”的现象比较普遍。本院是一所中等规模的三级综合医院，为了解决科室床位使用率低，人力资源浪费大的矛盾，推行了“机场式”护理模式取得良好效果。     

高密市人民医院推出三种人性化服务模式

高密市人民医院在开展医院管理年活动中，坚持“创新模式、发展特色、注重效应、服务患者”的经营思路，推出三种人性化服务模式，积极拓展了医疗服务工作的全面性和广泛性，得到中国医院学会“全国百姓放心医院动态管理考核小组”的充分肯定。     

公立医院与政府“院府合作”模式的创新实践——以南京医科大学第一附属医院为例

南京医科大学第一附属医院不断探索完善优质医疗资源和政府主导双重效应的“院府合作模式”，即一方面强调“府为主导”，突出政府保障民生的主体责任；另一方面强调“院为载体”，突出医院提供医疗服务的载体作用。自2007年以来，共发展出盛泽模式、栖霞模式、宿迁模式、溧阳模式四种模式。“院府合作”可实践、可复制、可推广，形成了政府促民生、群众享实惠、医院共发展、社会得满意的四赢局面，为护佑全民健康、助力全面小康探索了一条全新路径。     

竞争情报与医院战略管理整合应用模式

在深化医院改革的过程中,要改变制约医院发展的管理模式,走出新路。本文提出了竞争情报与医院战略管理整合的视角,即应用模式的研究。阐述了该研究的缘由、“应用模式”的概念、特征,以及应用模式研究思路,为推进医院现代化管理的理论研究提供参考。     

高州模式“高”在何处

在地处粤西半山区的高州市人民医院，近八年来在没有获得任何“政府补偿”的情况下，从一个默默无闻的县城医院发展成为远近闻名、信誉卓著的高水平医院。无论是广东省还是卫生部，都高度肯定高州市人民医院创造的“平价”奇迹，并决定在广东省乃至全国范围内推广“高州模式”。“高州模式”是否可复制？     

“先看病后付费”收费模式——医疗收费模式探索的新视角

备受关注的“先看病后付费”医疗收费模式，是对“先付费后看病”的传统模式创造性地进行“程序倒置”，重造就诊流程，实行医疗收费真正的“后付制”改革。不仅彻底打破了卫生系统“不付费不看病”的一惯做法，更有效制衡医方在医患关系中的优势地位，是医院收费模式探索的新视角和重大创新之举。文章对比进行了分析讨论。     

"诊疗组"服务模式开展前后住院费用的比较与探讨

自2000年3月卫生部对天津第三中心医院开展的病人选医生这一诊治模式肯定和推广后，近年来，许多医院都实施了病人选医生这一诊治模式。某院是一家三级乙等妇幼保健专科医院，于2001年开展了门诊“病人选医生”这一诊治模式，经过一段时间的试验和探索，于2003年10月全面开展以“病人选医生”为基础的“诊疗组”服务模式，即病人的门诊和住院诊治均由其选的同一诊疗组服务的模式，其在诊治中所产生的费用归属于该诊疗组，诊疗组效益在考核其医疗质量的同时，直接与诊疗组的收入和成本相关，由此对病人住院医疗费用的统计分析，能为进一步深化和完善这一诊治模式提供有价值的参考依据。     

政府与非政府组织在促进流动人口生殖健康服务的互动与互补作用探讨

在联合国世界卫生组织技术支持下，云南健康与发展研究会和昆明医学院健康研究所与云南省昆明市西山区政府紧密合作，在西山区开展了一个促进流动人口生殖健康行动性研究（2004～2007年），旨在探索流动人口生殖健康领域一种以人为本的模式。研究采用准实验设计，在干预前后分别进行社会调查，从社区、患者、服务提供者和服务机构4方面收集定量和质性资料进行研究分析。干预措施包括行政制度和公共政策改革、服务提供者意识与技能培训、流动人口社区健康促进，以及督导与管理机制改善。本文对该研究在人口与计划生育领域中政府与非政府组织的互动和互补方面的有益尝试进行初步分析与探讨。     

成都和沈阳社区卫生服务能力及条件建设评价研究

目的了解成都和沈阳两市UHPP项目区社区卫生服务提供能力及条件建设状况，为各级政府和卫生行政部门完善社区卫生服务提供客观依据。方法利用现有资料及定性和定量调查资料，对UHPP项目区的社区卫生服务能力进行评价。结果UHPP项目通过开展一系列针对社区卫生人员能力建设的培训活动，提高了社区卫生人才队伍的整体素质和服务水平，促进了社区卫生服务培训规范化模式的形成，提高了卫生行政和有关部门组织社区卫生服务培训的能力。结论成都和沈阳两市社区卫生服务机构人员素质得到提高，工作条件得到改善。     

Recent changes in selected local health departments: implications for their capacity to guarantee basic medical services

Local public health departments traditionally have been supported as providers of preventive care and, in some jurisdictions, as guarantors of other essential services to vulnerable populations that usual providers do not reach. In the 1980s, the responsibility for allocating federal grants for public health shifted to the states, and those funds were reduced by about 20 percent. These circumstances, coupled with a deep recession, raised questions about the capacity of public health agencies to guarantee basic medical services for their constituent populations. Comparing information obtained in 1978-1979 with that obtained in 1982-1983 from 15 local health departments geographically dispersed throughout the United States, we found that, in the aggregate, the capacity of the departments to provide and guarantee personal health services had diminished. These departments had maintained what a panel of experts judged to be notable personal health services programs in the late 1970s. However in 1982-1983 (with some exceptions) the departments as a group had smaller budgets and staffs than they'd had four years earlier, had undergone extensive turnovers in leadership, found their relationships with the private sector increasingly strained, experienced a greater demand for their services, accentuated income-producing services, and were realigning themselves politically to interact more with state and local governments than with federal agencies. One department ceased to function as a guarantor of care; the capacity of four others to fulfill this role was jeopardized. The resourcefulness and adaptability of the remaining departments enabled them to continue to guarantee basic medical care for their service populations.     

A preliminary comparison between local public health units in the Canadian Province of Ontario and in the United States.

This comparison between public health departments in the United States and in the Canadian Province of Ontario addresses the funding and staffing and the size and program content of local health departments after Canada''s national health reform provided universal access to personal health services. Ontario''s local health departments are required to provide a uniform set of public health services. In the United States, there is substantial variation among jurisdictions in kinds and amounts of services delivered. Ontario health units have staff sizes and budget levels that increase in proportion to population served, like those in the United States. But in Ontario, per capita expenditures increase with decreasing population, while the reverse is true in the United States. This anomaly may be attributed to lack of critical staff or elimination of key programs in small U.S. departments. Medical care of indigents probably accounts for the increased per capita costs seen in very large U.S. health departments. An estimated price for uniform public health services meeting the Ontario requirements in all U.S. jurisdictions as they were organized in 1989 is $5.8 billion per annum (not adjusted for inflation). If smaller health departments were consolidated, a savings of more than $1 billion could be realized. Even with this reorganization, average expenditures in smaller U.S. health departments would need to be doubled, and staff sizes increased by about 50 percent to meet Ontario''s uniform public health program standards.     

17所县以上医院临床医疗质量检查结果及分析

对１７所县以上医院临床医疗质量的检查结果进行分析,发现当前主要存在的问题及住院医师２４小时负责制、三级医师查房制、疑难病例死亡病例讨论制、手术前病例讨论执行不严,病历书写的内涵质量不高,滥用抗生素情况相当严重,学科建设和人才培训方面也存在不少问题针对上述情况指出,必须科 室建设,抓好制度产,制定重点学科建设规划、努力提高医务人员的素质。     

新时期的医院管理:由政策依赖转入市场导向——析广东省中医医院“双线六制”管理模式

医院如何转换内部管理机制以适应新的形势,广东省中医医院以市场为导向的管理模式提供了很好的借鉴。介绍了其“双线六制”管理模式及其绩效并进行了简要的理论分析。     

Privatization and the scope of public health: a national survey of local health department directors

OBJECTIVES: This study sought to obtain and analyze nationally representative data on (1) privatization of local health department services, (2) local health department directors' beliefs and perspectives on the desirable role and focus of health departments, and (3) the influence of these views on privatization practices. METHODS: A stratified representative national sample of 380 local health department directors was drawn, and 347 directors were interviewed by telephone. Logistic regression established the independent effects of various factors on decisions to privatize. RESULTS: Almost three quarters (73%) of the local health departments privatized public health services of some type. The 12% of the directors who believed that local health departments should be restricted to the core public health functions and move entirely out of direct provision of personal health care were more likely to privatize services. The 77% of the directors who believed that local health departments should be involved in an increasing array of social problems were more likely to privatize. CONCLUSIONS: Privatization has quietly and quickly become commonplace in public health, and privatization practices are intimately related to divergent conceptions of public health and the role of local health departments.     

Statutory authorizations for the work of local health departments.

A study of public health statutes of the 50 states identifies 44 specific services or functions that are assigned to local health departments by all or some of the states. Authorizations are most commonly assigned conjointly both to local and state health departments; exceptions are identified. Data suggest striking inconsistencies between what local health departments are authorized to perform and the services they actually render with regard to a selected group of programs that involve personal health services. The full scope of authorizations for local health departments is not revealed by examination of public health statutes. For this reason, among others, development of up-to-date health codes for all states would be beneficial.     

Public health as a catalyst to the growth of municipal departments in early Toronto

Municipal public health history generally is concerned with the history of the Board of Health and the Department of Public Health. This article, in contrast, examines the role of health concerns as a catalyst to the expansion of municipal services, using City of Toronto Council Minutes and By-laws dating from 1834, and shows close links between the growth of a number of local government departments and concern for the public's health. In particular, 16 of 36 city services (44%) were found to have health concerns as contributors to their establishment and growth; in 10 of the 16, health had a major impact on growth, while in six cases, the influence of health issues was minor. Synthesis of the data revealed sanitation, safety, and the provision of services to be the common health themes which spurred the development of municipal departments. Moreover, three civic services were driven by two or more of these public health themes.     

The Relation of FIMR Programs and Other Perinatal Systems Initiatives with Maternal and Child Health Activities in the Community

OBJECTIVES: To evaluate the association of the presence of a fetal and infant mortality review (FIMR) program, other perinatal systems initiative (PSI), or both in a community with the performance of essential maternal and child health (MCH) services by local health departments (LHDs). METHODS: Data were obtained from telephone interviews with professionals from LHDs across the United States. Logistic regression was used to estimate the odds of a LHD conducting each essential MCH service in communities with and without FIMR programs or with and without PSIs, adjusted for geographic area. RESULTS: Of the 193 communities in the sample, 41 had only a FIMR program, 36 had only a PSI, 47 had both programs, and 69 had neither. The presence of a FIMR was related to greater performance of essential MCH services in LHDs in six areas: data assessment and analysis; client services and access; quality assurance and improvement; community partnerships and mobilization; policy development; and enhancement of capacity of the health care work force. Similar findings were noted for the same broad essential services for PSIs. The comparisons of LHDs in FIMR and non-FIMR communities, however, showed greater involvement of communities with a FIMR program in essential MCH services related to data collection and quality assurance than were found for comparisons of LHDs in communities with and without a PSI. The presence of a PSI was uniquely associated with conducting needs assessments for pregnant women and infants, participation in coalitions for infants, promoting access for uninsured women to private providers and involving local officials and agencies in health plans for both populations. When both programs were present, LHDs had a greater odds of engaging in essential MCH services related to assessment and monitoring of the health of the population, reporting on progress in meeting the health needs of pregnant women and infants, and presenting data to local political officials than when either program alone was in the community. CONCLUSIONS: Local health departments in communities with FIMR programs or PSIs appear to be more likely to conduct essential MCH services in the community. Some of these relations are unique to FIMR, particularly for data collection and quality assurance services, and some are unique to PSIs, for example those that involve interaction with other community agencies or groups. Performance of the essential MCH services also appears to be enhanced when both a FIMR program and a PSI are present in the community.