当前医疗服务消费需求变化趋势分析与对策研究

为了明确当前医疗服务消费需求的变化趋势,笔者运用某三级甲等医院2003～2005年的“十大满意事件”评选调查资料统计分析,引进“服务产品”理念,以患者“满意”和“不满意”作为衡量医疗服务产品消费的唯一标准,从而探索医疗服务与质量、创新、服务、文化四大关系,增加患者对医院的信任感,培养医院潜在的忠诚顾客,不断满足患者需求,从而推动医院管理及其医疗服务水平上新的台阶。     

浅谈医疗服务流程的再造

医疗服务流程再造就是以业务流程再造理论为指导,以“流程导向”为目标,以“顾客满意”为标准,运用现代人文手段,通过建立起流畅的服务链,对院内所有工作流程和与院外沟通的工作流程都加以改造。医院是为人类社会提供医疗服务的经济实体,为满足不同层次患者的医疗服务需求,医院必须不断地改善医疗服务的管理工作,提高医疗服务能力,争取用最短的时间和最低的成本提供最令患者满意的医疗服务,才能在竞争激烈的市场中生存并壮大起来。1树立顾客满意经营理念顾客满意是质量的最终标准,也是医疗服务组织生存和发展的先决条件。概括而言,其内容包括以下几个方面:(1)理念满意。这是医疗服务组织经营理念带给顾客的满意状态。(2)行为满     

住院患者对医疗服务不满意因素调查分析

目的对住院患者不满意的医疗服务质量进行分析研究,为医院质量管理提供决策依据及质量改进方向。方法采用患者医疗服务不满意调查问卷及卡诺调查问卷,在患者及家属自愿的基础上进行现场问卷调查。结果患者对医疗费用(59.8%)、服务流程(37.9%)、健康教育(33.3%)、服务环境(32.2%)不是很满意。23项不太满意的服务质量中5项必备质量(M),13项单向质量(O),5项魅力质量(A)。结论医院应该首先要从患者需求切入,完善必备质量,增加单向质量(降低医疗费用,优化服务流程),在此基础上再关注魅力质量(健康教育、服务环境)的创造,减少患者不满意因素,提高医院服务质量,增强医院的综合竞争力。     

主院患者对医疗服务不满意因素调查分析

目的对住院患者不满意的医疗服务质量进行分析研究,为医院质量管理提供决策依据及质量改进方向。方法采用患者医疗服务不满意调查问卷及卡诺调查问卷,在患者及家属自愿的基础上进行现场问卷调查。结果患者对医疗费用（59．8％）、服务流程（37．9％）、健康教育（33．3％）、服务环境（32．2％）不是很满意。23项不太满意的服务质量中5项必备质量（M）,13项单向质量（0）,5项魅力质量（A）。结论医院应该首先要从患者需求切入,完善必备质量,增加单向质量（降低医疗费用,优化服务流程）,在此基础上再关注魅力质量（健康教育、服务环境）的创造,减少患者不满意因素,提高医院服务质量,增强医院的综合竞争力。     

价值链管理与医院服务流程再造

医疗服务是一个整体的产品概念,医疗服务从后台、前台一直延伸到顾客,在任何一个环节出现问题,都可能会影响到服务的整体效果。对医疗服务而言,核心利益是疾病诊治能力,这是患者就医的根本所在,是医疗服务最核心的内容。医疗消费是一个服务过程,同时,让患者满意也是一个全员营销过程,在流程中的任何一个环节出问题都可能引起患者不满意,所以,医疗服务流程的再造,成为医院管理者竞相探讨的问题。1医疗服务中常见问题的诊断近年来,我国医疗系统的建设有了飞跃式的进步,医院系统的功能日益增强。然而,由于卫生体制等原因,本应该形成一条“价值…     

营利性医疗机构门诊患者人口学特征及花费调查

随着医学模式的转变和市场经济的不断发展，患者对医疗服务质量的要求越来越高，以患者为中心，提供以人为本的医疗保健服务，是21世纪医院创新经营和应对医疗卫生市场国际竞争的关键一步。患者满意度调查不仅是反映医疗服务质量的重要渠道，更是医疗质量考评体系中不可缺少的一个环节。为了解患者对医疗服务的满意程度，     

信息不对称环境下医疗服务患者满意度研究*——以山东省三甲医院为例

目的:以山东省3所三甲医院为例,分析信息不对称环境下医疗服务满意度现状,为完善医院管理与提高服务质量提供决策依据。方法:按照单纯随机抽样方法对门诊患者和住院患者进行现场问卷调查。结果:门诊患者医疗服务满意度从高到低依次为医疗环境与设施、服务态度、服务过程、服务结果、医疗费用和等待时间,住院患者医疗服务满意度从高到低依次为服务态度、服务过程、医疗环境与设施、服务结果、等待时间和医疗费用。结论:在整体水平上,患者满意度相对较高;门诊患者最不满意的项目是等待时间长,住院患者最不满意的项目是医疗费用高。提示医院应有针对性地提高信息不对称环境下患者的医疗服务满意度。     

住院患者就医体验和服务指标重要度调查分析

目的:探索研究住院患者就医体验及其重要度对医疗服务质量的要求.方法:采用住院患者对医疗满意度调查表和期望值调查表作调查问卷,分析测量患者对入院过程、住院期间一般服务、住院期间治疗服务、患者意见管理、环境设施与后勤服务、出院过程与出院后安排等环节满意度和重要度的差异,得出住院患者对医疗服务质量各环节的不同需求.结果:住院患者对不同项目医疗满意度与重要度存在较大差异,提示该医疗服务有一定的整改需求.结论:根据患者对医疗满意度和重要度的差异,可以准确评价患者及其家属的需求,从而指导临床工作,并可以将此作为改善医疗服务质量、提高患者满意度的有效措施.     

医疗服务行业的情感管理及对策

我国医疗卫生体制改革提出了要缓解老百姓"看病难、看病贵",医疗机构服务形式要多样化,实现医患双赢的目标.随着医改的深入,研究探讨医疗服务行业医患双方的情感价值,找出医疗服务中使患者评价服务效果不满意、满意、感动的成因日益重要.医疗服务作为高风险、高专业化、高人性化的服务业,应从完善制度、建立工作规范和简化流程着手,建立起获得医患双方理念满意、行为满意、视听满意的运行机制;做好医患沟通交流,加强服务环节和过程管理,使医院的服务等于或高于患者的期望值,从而促进医患和谐,提高医疗服务质量水平,提升患者满意度.     

医院门诊服务需求调查分析

目的探讨医院门诊服务需求状况及其影响因素。方法自行设计调查问卷,对湛江市1所三级甲等医院的门诊就诊者进行服务需求调查,采用t检验、方差分析以及因子分析对调查结果进行综合分析。结果医院就诊者从性别、年龄、付费方式、文化、居住地和付费方式分析,对医院的医疗质量评分较高,对医疗费用评分较低;不同性别、年龄、不同文化层次对需求侧重点不同;因子分析得到6个公因子,归纳为:医疗环境,服务水平,医疗便利程度,医疗费用,医质量,患者权益。结论患者门诊医疗需求具有多样性,医院应重视为患者解除病痛、保证医疗安全、尊重患者、提高服务水平,满足不同层患者需求。     

Measuring change in health status of older adults at the population level: The transition probability model

Background  

The current demographic transition will lead to increasing demands on health services. However, debate exists as to the role age plays relative to co-morbidity in terms of health services utilization. While age has been identified as a critical factor in health services utilization, health services utilization is not simply an outcome of ill health, nor is it an inevitable outcome of aging. Most data on health service utilization studies assess utilization at one point in time, and does not examine transitions in health service utilization. We sought to measure health services utilization and to investigate patterns in the transition of levels of utilization and outcomes associated with different levels of utilization.     

大型三甲医院与政府联合举办社区卫生服务中心运作模式分析

大型三级甲等医院与区政府联合举办社区卫生服务中心,缓解医院门诊压力,解决居民看病难问题,同时为出院患者提供延续治疗服务。此模式社区卫生服务中心业务用房和医疗设施设备的配置均由地方政府免费提供,交由医院独立经营管理,服从地方卫生主管部门的行业管理。该中心成立三年以来,随着知晓率不断提升,业务工作量逐年呈现大幅度上升,相当于成都相似规模其它社区卫生服务中心的3倍以上,病人满意度大于99%。三甲医院与区政府联合举办社区卫生服务中心,高水平的基本医疗技术赢得了社区居民的高度信任,极大的提高了中心的知名度,促进了公共卫生服务的开展;公共卫生服务的有序开展进一步提升了中心基本医疗业务的知晓率,促进居民选择就近就医,真正实现了分级诊疗。     

Analysis of factors influencing the outpatient workload at Chinese health centres

Background  

Although the community health service system is now established in China, the utilisation of the community health service institutions is low due to the lack of a gate-keeping role of the primary health service providers and referrals among the three-tiered health service institutions. In addition to this, patients who can afford to pay, often seek best services in big hospitals to guarantee the quality of care. Thus, the need of guiding the patients to the community health services and increasing the utilisation of the community health service institutions is becoming an urgent problem, which hinders the future development of community health services. This study focuses on the question of how to increase the utilisation of Chinese community health centres (HCs).     

Healthcare-seeking patterns among immigrants in Portugal

Equity of access to health services is a major concern as it is an important precondition for positive health outcomes. However, inequities in use of health services among immigrant populations persist. Despite the increasing research in the field, patterns of healthcare seeking among immigrant populations and its associated factors are not fully understood. This study aimed to investigate healthcare-seeking patterns among immigrants in Portugal and identify factors associated with utilisation of health services. A cross-sectional study was conducted between October 2008 and May 2009 with a sample of 1,375 immigrants residing in the Lisbon region. Data were collected through a structured questionnaire applied by trained interviewers. Two stepwise logistic regressions were conducted to identify which factors were associated with utilisation of the National Health Service (NHS) and with healthcare seeking for the first time in Portugal at the Primary Health Care service, estimated by calculating odds ratios and 95% confidence intervals. Among participants, around 77% reported having used the NHS; 50% sought health-care for the first time at the Primary Health Care service and 33% at the emergency room. Lower odds of having used the NHS were associated with being male, Brazilian or eastern European compared with being African, and undocumented. Lower odds of having sought health-care for the first time at the Primary Health Care service were associated with being male and undocumented. These results suggest that further efforts are needed to tackle inequalities in access to care and promote the utilisation of health services, particularly among the more vulnerable immigrant groups. Increasing appropriate utilisation of health services, including the primary and preventive care services, may lead to better health outcomes. Immigrants' involvement and participation should be incorporated into the development of health strategies to improve access and utilisation of healthcare services.     

Case management in mental health services:the role of community mental health support teams

The progressive reduction in the numbers of hospital places available for people with mental health problems has led to an increasing demand on community support services. One response has been the development within social services departments of community mental health support teams, which employ largely unqualified staff who offer support to people with longer term mental health needs. The paper examines to what extent the practice of one authority's support teams reflects an appropriate ‘case management’ style of service, as developed in the USA to address the needs of long-term community patients. Key features of this approach are identified, and used as the basis of analysis of the support teams' practice in relation to 214 cases. It is concluded that a ‘case management’ model can be appropriate for work involving unqualified staff, provided that the service structure as a whole enables access to other skills as appropriate. Two specific risks are identified: firstly that the service is developed because of cost rather than appropriateness; and secondly that the service can rapidly become silted up with increasing numbers of people who need service of indefinite duration.     

更新医疗服务观念 适应医学模式转变

世纪之交,社会迅猛发展,医学不断面临新的挑战、新的变化。生态环境失衡,人体内环境紊乱,医源性、药源性疾病增多,人口老龄化等等现实问题,需要人们更新健康观念,发展社会医学、行为医学,加强卫生宣教,转变医学模式来解决这些社会现实问题。对于医院来说,要加大临床心理医学在实践中应用的力度;培养良好的医患、护患关系;建立临床心理学科,配备专门的医生和护士来开展工作。     

连续—碎片—整合——我国农村三级医疗卫生网络服务提供模式的历史演变及启示

几十年来,经济社会的巨大变革所引起的政府卫生决策意识改变导致我国农村卫生服务网络提供连续性卫生服务呈现明显的波动性：计划经济时代,＂分级分工,就近就医＂的服务模式曾是我国连续性服务的理念萌芽和初始实践;改革开放以来则形成了＂自由择医,碎片化提供＂的非连续服务模式;2009年公共卫生服务均等化实施后则呈现＂基层就医,连续综合＂的整合服务模式的发展趋势。上述三个阶段服务提供模式的波动特征背后隐含着不同时期政府意识形态对卫生服务治理的深刻影响,充分证明了基本医疗保健服务具有明显的政治脆弱性。这种历史演化特征的政策动因为我国以及转型国家维持卫生服务网络延续连续性服务模式提供了诸多政策经验和启示：重视基本保健策略,建立完整的基层卫生体系框架和系统的、整合的运行机制以及重视以人为中心的服务提供理念等。     

我国老龄健康公平社会决定因素分析及对策

我国人口健康水平不断提升的同时老龄健康公平差距客观存在,而影响健康公平的社会决定因素又处于动态变化之中。本文依据WHO健康社会决定因素理论框架对我国老龄健康公平社会决定因素进行分析,提出了除以往影响老龄健康公平的共识性社会决定因素外,还包括宏观层面的老龄健康政策、老龄人口流动、科技发展和死亡认知等,个体层面的退休后工作及社会参与等,日常生活环境层面卫生服务体系的老龄友善程度,如老年卫生资源配置公平性、老年人对相关服务的可获得性及利用公平以及重大公共卫生事件对老龄健康公平的冲击等;并针对性提出要进一步加强对老龄健康公平的认识与评估,多措并举、多种公平兼顾缩小老龄健康公平差距,助力实现健康老龄化。     

Challenges for psychosocial rehabilitation services in the Lisbon Metropolitan Area: A qualitative approach

In Portugal, a mental health reform process is in place aiming to redefine the model of service provision. In 2008, a National Mental Health Plan (NMHP) was approved to provide policy guidance over the transition period. The NMHP intended, among others, to develop community‐based services, with a specific focus on rehabilitation and deinstitutionalization. This study aims to explore the perspectives of service managers of psychosocial rehabilitation services regarding the main challenges to support the community living of persons with severe mental illnesses (PWSMI) in the Lisbon Metropolitan Area (LMA). The paper also contextualises the provision of psychosocial services within the country's mental health reform process and characterises the profile of service users in socio‐occupational units (SOUs) of the LMA. Semi‐structured interviews were performed with all SOUs’ managers of the LMA (n = 13). Information regarding service user characteristics was collected based on service records (n = 344). Interviews were analysed according to the framework methodology. The results of the interviews were triangulated using document analysis. Fieldwork took place between June and July 2016. The findings suggest that the development of the mental health reform ensured significant changes to service delivery. Community‐based mental health organisations are an important actor for service provision. However, important asymmetries were identified in the provision of psychosocial care within the LMA. At the same time, family carers are perceived as responsible for ensuring a large part of the social needs of the PWSMI but there is an increasing concern with their own ageing processes. As a conclusion, it is highlighted the current inequality between services and the need to contemplate a life‐course perspective that comprehends the ageing process of caregivers poses an emerging challenge for psychosocial rehabilitation. These findings are also important for other low‐ and middle‐income countries passing through similar reforms.     

厦门市社区卫生模式改组及其效果分析

目的:评价社区卫生服务质量,为社区卫生服务的改革发展提供科学依据.方法:根据社区卫生服务功能的6个方面,选择具有代表性的12项指标,应用综合指数评价的方法进行综合评价.结果:社区卫生服务质量综合指数总体呈上升趋势.结论:社区卫生服务质量的综合指数从总体上呈逐年上升的趋势,但相关的制度、政策需进一步健全.