积极探索建立医疗机构合理补偿机制和分配制度全面推进医疗改革

国务院办公厅转发国务院体改办等部门《关于城镇医药卫生体制改革的指导意见》(简称《指导意见》)后,特别是2000年7月“上海会议”以来,安徽省认真学习贯彻《指导意见》和“上海会议”精神,结合安徽实际,确立了“提高质量、降低费用、调整机制、重点突破”的基本思路,选择建立和不断完善医疗机构合理补偿机制和分配制度为突破口,坚持落实医疗机构药品收支两条线、推行药品集中招标采购试点,合理调整医疗服务价格、建立医疗机构合理补偿机制,改革分配制度,强化医疗质量控制和医疗机构行风建设等工作,求真务实,注重实效,在全面推动医疗改革与发展方面取得了较大的进展。1 转变观念、领会实质,深刻认识建立与完善医疗机构合理补偿机制和分配制度在城镇医药卫生体制改革中的地位和作用     

对医疗改革中医疗机构面临问题的思考

随着我国体制改革进一步深化,市场经济体制逐步确立,医疗卫生系统改革应进一步适应新形势下经济体制的要求,转变思想,更新观念,加强经营管理,应对日益激烈的医疗市场竞争。1 坚持“以病人为中心”的服务理念1.1 医疗服务具有其特殊性。医疗服务的对象是人,医务人员提供的服务关系到人们的生命健康与安危,从某种意义上说,也正是因为有了病人,有了病人对医疗服务的需求,才使我们医疗机构、医务工作者有体现自身价值的机会。简言之,因为有了病人,才有了医院,医院是为病人设立的,     

医疗改革前后患者就诊消费情况调查分析

采用了自行设计的医疗改革前后患者的就诊消费情况问卷调查表，于2004年4月至5月间对杭州市内省市级综合性医院和社区医院的门诊就诊者进行了问卷调查。调查结果显示：医疗改革前后患者在就诊感冒一类较轻疾病或病情较稳定的慢性病时的消费选择发生了明显改变，医改后得此类疾病的患者选择社区医院的频数增长显著；而在就诊花费较大或病情严重的疾病时惠者的消费选择频数分布改变并不明显。结果还显示近一半患者认为医改后医疗费用有所上升，30％的患者认为无变化，20％的患者认为有所下降。医改后也有55％的患者曾有在医院开药方，再到平价药房买药的经历。建议各级医院要审时度势，分析自身的情况，扬长避短，合理定位，调整自身的服务方式和服务结构，发挥各自的优势，为患者服好务。     

医疗服务体系的结构调整和医疗机构的产权改革

医院改革曾在卫生系统内进行过激烈争论[1 3] ,随时间推移 ,当时争论的焦点已成为现实[4 6 ] 。而当前 ,医院改革中出现了新的值得研究的问题 ,即医院治理结构问题。医院治理结构应该包括两个层面上的结构问题 :一是宏观层面我国医疗服务体系的基本结构问题 ;二是具体医疗机构内部的治理结构问题。现就此问题进行探讨。一、卫生系统改革压力的主要成因从卫生系统绩效的总体看改革的压力主要来自筹资公平性 ,这在世界卫生组织 2 0 0 0年报告中体现的比较清楚[7] 。所以 ,现就城市医疗机构产权制度改革的策略选择进行探讨。目前 ,城市卫生系…     

医疗人事制度改革初探

一、加强人才队伍建设的成绩 1.形成人才竞争态势 近10年来,我院解放思想,更新人才观念,确立了“引得进、留得住、出成果、早成才”的人才管理目标,形成“优化环境、增加投入、巩固发展、开拓渠道、突出重点”的医院人才建设新思路。既注重院内自己培养人才,又注重从外地引进人才,避免人才退化。先后引进硕士、博士研究生19人,接收省内外大、中专毕业生160多人,其中,医疗专业全部为名牌医学院校本科毕业生。使院内人员知识结构发生了变化,使之在学术上有一种紧迫感和相互间的学术竞争性,以促使各专业技术的发展。     

我区医疗改革面临的问题与思考

为了解我区医疗机构体制改革的现状，剖析存在的主要矛盾和问题，探索改革的有效途径和措施，推进医疗资源优化配置，解决群众看病难、看病贵的问题，不断提高医疗服务质量和水平，为人民群众提供优质、价廉、便捷的医疗服务，对我区256所一二三级医疗机构改革现况进行调研，并提出了相应的对策。     

宁夏医疗服务价格改革的做法及建议

国务院《关于城镇医药卫生体制改革的指导意见》和国家计委、卫生部《关于改革医疗服务价格管理的意见》均提出 ,在总量控制范围内 ,要综合考虑医疗成本、财政补助和药品收入等因素 ,调整不合理的医疗服务价格 ,体现医务人员的技术劳务价值 ,完善医疗服务价格管理体系 ,推动城镇医药卫生体制改革顺利进行 ,满足人民群众的基本医疗服务需求 ,促进医疗机构之间开展有序竞争 ,健康发展。要实现上述政策目标 ,须结合本地的实际情况 ,综合考虑各种具体因素 ,制定出切实可行的实施方案 ,才能保证这项改革工作的顺利进行。现将我区医疗服务价格改革…     

医疗改革要咬住细节不放松

最终它能够承载百姓多少期待，不在于它提出了多么宏伟的目标，而在于细节设计上的可操作、无缝隙。细节决定成败，几乎在任何时候任何领域都是真理。     

2009～2010年《中国卫生事业管理》载文统计分析

以2009～2010年《中国卫生事业管理》杂志发表的论文及作者为研究对象,用文献计量学的方法,统计分析了载文的数量,栏目的设置,论文发表的时滞,影响因子,基金论文,作者合作度及其地区和系统分布,从一个侧面反映该刊被入选为08版中文核心期刊前后的发展情况及学术影响     

Protective effects of liraglutide on glomerular podocytes in obese mice by inhibiting the inflammatory factor TNF-α-mediated NF-κB and MAPK pathway

ObjectiveTo evaluate the protective effects of Glucagon-like peptide-1(GLP-1) receptor agonist (liraglutide) on glomerular podocytes of obese mice, and explore the possible underlying mechanism.MethodsTwelve of the thirty-four healthy and clean male mice were randomly selected as the normal control group. The remaining twenty-two mice were included in the high-fat diet (HFD) feeding group. After twelve weeks of high-fat diet and normal diet, two mice each from the HFD feeding group and the normal control group were randomly selected and sacrificed to suggested that the modeling was successful in the HFD feeding group. Then, twenty mice were randomly divided into HFD + liraglutide group (liraglutide group, n = 10) and HFD group (n = 10). The morphology and the structure of glomerular podocytes were observed using electron microscopy. Podocyte foot process diameter, glomerular basement membrane thickness were measured. ELISA was performed to determine the serum tumor necrosis factor α (TNF-α) level. The expression levels of TNF-α protein and nuclear factor-kappa B (NF-κB) in kidney tissues, extracellularsignal regulating kinase(ERK), c-Jun N-terminal kinase (JNK) and p38MAPK in the mitogenactivated protein kinases(MAPK) pathway were detected by western blotting.ResultsHFD-feeding caused significant renal injury, podocyte pathological changes, podocyte foot process diameter and glomerular basement membrane thickness were significantly increased compared with the control group. Liraglutide injection significantly alleviated HFD-induced effects on renal functions and podocyte morphology, as 24 h urine protein, urinary albumin and podocyte histomorphology. Moreover, HFD-induced Inflammatory reaction were obviously attenuated by Liraglutide administration, so did the HFD-induced activation of TNF-α-mediated NF-κB and MAPK pathways.ConclusionLiraglutide reduced urinary albumin excretion in obesity-related glomerulopathy model mice, and improved podocyte morphology and structural damage. The mechanism may be partly related to the inhibition of TNF-α-mediated NF-κB and MAPK pathways.     

The prevalence of carboxyhemoglobinemia in New Yorkers and its effects on the coronary and systemic circulation.

Carboxyhemoglobin saturations ranging from 8.11 to 1.56% were found in a sample of more than 1,000 individuals engaged in various activities in New York City. The difference from lowest to highest carboxyhemoglobin in nonsmokers was 1.58%; in smokers it was as great as 5.0%. Experimental elevation of carboxyhemoglobin to levels similar to that seen in cigarette smokers produced a decrease in arterial and venous oxygen tensions and an increase in cardiac output and coronary blood flow. In contrast to the effect on the systemic vascular bed, carbon monoxide inhalation produced a decrease in myocardial oxygen extraction. These observations suggest that changes in coronary blood flow are a useful indicator of the effects of carbon monoxide when hemodynamically significant coronary artery disease prevents the expected increase in myocardial blood flow.     

Influence of Toxoplasma on manifestations of Moloney virus infections

Considerable evidence documents the importance of co-factors, including the immune response, in expression of oncogenicity of tumour viruses. To determine whether a common protozoal infection that can depress lymphocyte function alters manifestations of oncogenic virus infection, a mouse model of Toxoplasma infection with depressed T lymphocyte function was developed. In this model, Toxoplasma depressed blastogenic transformation to the T-cell mitogen Concanavalin A and primary antibody response to sheep red blood cells which requires T cell help. Uninfected and Toxoplasma-infected mice were then infected with Moloney leukaemia or Moloney sarcoma viruses and development of lymphoma and sarcoma were evaluated. Toxoplasma infection, which induced depression of T-cell function, decreased the incidence of Moloney sarcoma virus induced rhabdomyosarcomas but did not alter progression or regression of tumour in those mice that developed tumour. Conjoint infection with Toxoplasma and Moloney leukaemia virus did not increase incidence of lymphoma when compared with incidence of lymphoma in mice infected with Moloney leukaemia virus alone.     

Effects of Statins on Relative Risk of Fractures for Older Adults: An Updated Systematic Review With Meta-Analysis

ObjectivesBasic and translational studies have found statin treatment may have beneficial effects on bone metabolism; however, whether statins reduce the risk of fractures in older adults is still in debate. Therefore, we aimed to summarize the up-to-date evidence on risk of fracture among older individuals with statin use.DesignSystematic literature review and meta-analysis.Setting and ParticipantsTwenty-one observational studies and 2 randomized controlled trials (RCTs) comprising 1,783,123 participants aged at least 50 years were retrieved from PubMed, Embase, and the Cochrane Library.MeasuresWe estimated summary relative risks (RRs) with 95% confidence intervals (CIs) using the random-effects model. Subgroup analysis was performed to explore the potential source of heterogeneity.ResultsMeta-analysis of observational studies suggested that statin treatment was significantly associated with reduced risk of all fractures (RR 0.80, 95% CI 0.72–0.88), among which hip fracture (RR 0.73, 95% CI 0.64–0.82) and lower extremity fracture (RR 0.69, 95% CI 0.54–0.88) showed consistent results, whereas no significant decreased risk was observed with respect to other fracture sites. Subgroup analyses showed that among the statin users, fracture risk was reduced in both genders, older adults ≥50 years old, those with short drug duration (< year) or medium to high statin dose (>90 defined daily dose), those taking atorvastatin, and in Europeans and Americans. Meta-analysis of RCTs revealed no significant effect of statin treatment on the risk of fractures (RR 1.00, 95% CI 0.87–1.15).Conclusions and ImplicationsOverall, the findings of this updated meta-analysis indicated no solid evidence supporting that statins have a beneficial effect associated with reduced risk of fractures for older adults. Our findings should be further confirmed in future larger population-based prospective cohort studies or well-designed RCTs.