基于供方的区域专业公共卫生服务经费测算方法探索

从供方角度,对区域专业公共卫生服务经费测算方法进行了初步探讨。介绍了测算的目的、原则和思路,相关概念和测算依据,测算程序及所需资料,设计了较为系统的测算公式,简要讨论了需要进一步研究的问题。     

对医院医疗服务项目成本测算的探讨

目的:测算医院医疗服务项目成本.方法:内容上采用完全成本测算,方法上采用分布测算,形式上采用账外成本测算.在科室分摊时,将采用阶梯分摊法,并寻求合理的分摊系数.项目成本测算采用系数法结合当量法,并通过专家咨询确定代表项目.结果:测算现有的测算医疗服务项目成本的实际水平,为合理地制定医疗服务项目的价格、理顺医疗服务价格内部的比价关系、更好地为医疗服务价格的制定和医院的经济管理服务.结论:医院医疗服务项目成本的测算是政府主管部门在制定医疗服务项目价格时依据的前提和基础.     

艾滋病防治费用测算方法研究

艾滋病防治经费的测算是艾滋病防治工作稳定开展的前提。重点分析艾滋病防治费用测算的基本原则、测算主要内容、研究现状以及存在的问题,并提出解决措施。     

成本测算软件简介

自１９９２年以来,我们一直在致力于成本测算方法的研究,先后提出了医院医疗服务项目成本测算方法,诊次、床日成本测算方法以及其他一些成本测算方法等,为了使这些成本测算方法能够更好地应用到实际工作中去。我们为这些方法编写了一个计算机软件—医疗服务成本测算系...     

基层门诊慢性病按人头付费测算方法比较研究*

目的：基于4种主要慢性病的实证数据比较测算基准人头费的两种方法，为我国推进以慢性病为主的门诊按人头付费提供方法学参考。方法：收集北京市大兴区患有4种慢性病的参保人数据，通过自上而下和自下而上两种方法测算按人头付费标准，比较测算结果及测算方法的优劣。结果：自上而下测算的高血压、糖尿病、脑血管3类患者人头费标准高于自下而上法测算的结果，自下而上法测算出的居民医保缺血性心脏病人头费标准较低，但不管用哪种方法职工医保测算出的结果均高于居民医保。自下而上法是基于历史数据测算的，结果更加符合实际。结论：自下而上测算人头费的方法对于我国现阶段来说相对科学合理。在地区内试行几年按人头付费后，再采用自上而下法可以更方便快捷地测算人头费标准。     

医疗服务项目成本分摊测算的探索

实行医疗服务项目成本分摊测算是加强疗养院科学管理的重要手段,是疗养院管理模式改革的重要组成部分。抓医疗服务项目成本分摊测算有助于合理利用疗养院资源,提高管理水平,增强成本节约意识,促进现代化疗养院管理制度的建立,形成高质量、高效益、适合市场经济规律的运行机制。1医疗服务项目成本分摊测算基本框架测算基本框架分3个层次,即院成本测算、科室成本测算和服务项目成本测算。院总成本由人力成本、固定资产折旧、材料成本、公务费、业务费、低值易耗物品和其他成本构成。医疗服务成本包括工资、补助工资、其他工资、职工福利费、社…     

农村公共卫生项目投入标准测算的思路与方法

借鉴成本核算思路与方法,研制了我国农村公共卫生项目投入标准的测算思路和方法及其所需要的资料来源途径,为进一步科学、合理地测算我国农村公共卫生项目投入标准提供了方法学依据。研究结果显示,农村公共卫生项目投入标准的测算思路包括界定公共卫生项目提供的"农村"范围、界定农村公共卫生服务项目、样本地区服务项目实际成本的测算、样本地区单位服务项目实际成本的测算、样本地区项目任务全部完成所需要标准成本和全国农村公共卫生项目投入标准测算等6步骤,资料来源途径和方法包括文献归纳分析、专家咨询论证、机构调查和常规报表资料的利用等。     

与新农合衔接后的农村医疗救助方案测算研究

与新农合衔接后的农村医疗救助方案科学合理,是确保救助对象获得最大受益,提高救助资金使用效率的关键所在。为此,本研究探讨了医疗救助方案测算的方法,提出了方案测算的流程、需要测算的指标及其计算公式,以及在方案测算过程中需要重点考虑的方面。     

两种卫生总费用测算方法产生差异的原因辨析

目的:分析筹资来源法和机构法两种卫生总费用测算方法之间的联系和差异,从而做到正确选择卫生总费用评价指标。方法:对某省4个地级市2011—2012年卫生总费用采用筹资来源法和机构法进行测算,并对不同方法的测算结果产生的差异数额及其原因进行比较分析。结果:由于反应资金运动角度不同,两种方法的测算结果存在有很大差异。4个地级市2011年和2012年均出现筹资来源法比机构法测算结果要高,且越是经济发达的地区,数据差距越大。结论:两种方法的测算结果产生差异的原因包括社会保障经费结余、人口向外流动、危重病人转院以及测算指标体系不同等,在测算时要根据实际需要选择相应的测算方法。     

全国部分地区卫生总费用调查分析

1994年7月,卫生部计划财务司下发文件,要求全国各省、自治区、直辖市卫生计划财务部门开展卫生总费用测算分析工作。经过3年的努力,多数地区已经基本掌握了卫生总费用筹资来源法的测算方法,并完成了1993～1995年的卫生总费用测算工作,其测算结果已经在当地卫生政策分析和研究中加以应用。现将部分地区卫生总费用测算结果综合分析如下:     

公立医院托管模式对区县医院服务能力提升的影响——以北京中医医院集团运行模式为例

采用案例研究的方法,以北京中医医院集团一家紧密型成员单位A医院为分析对象,就其产生背景、管理模式、运行机制、工作成效等方面进行概括和分析,创新性地提出了"管理同道、医疗同质、学科同根、文化同源"的医院集团管理理念,旨在为医院集团建设以及医院间托管工作顺利开展提供参考。     

Professional status in a changing world: The case of medicines use reviews in English community pharmacy

The health professions are engaged in an ongoing and dynamic process involving reflection and adaptation, with factors such as socio-economic and cultural developments and technological innovations compelling professions to respond to changed circumstances. This paper concerns English community pharmacy, where recent reforms provide financial incentives to deliver interventions, which have the potential for pharmacists to promote their knowledge and skills, as part of a professionalising strategy. The paper, drawing on interviews with 49 pharmacists, describes how responses to reforms are not necessarily in accordance with either national policy goals or enhancement of professional status. Debates about professional status and role extension have often focused on health professions’ subordination to medicine. This paper highlights the importance and interplay of other factors which help explain the inability to capitalise fully on the potential contribution to professional status, which reforms to extend professional roles afford.     

Community-based interprofessional education for medical, nursing and dental students

This paper presents final results from a 15-month project which evaluated the effectiveness of interprofessional education (IPE) for first and second year medical, nursing and dental students on a community-based placement. The paper initially discusses the current issues within the IPE literature. It goes on to provide background information of this placement. In presenting the project's methodology, the paper describes the use of a 'process-based' approach which tracked the education and social processes connected to IPE. Such an approach has helped overcome some of the problems of using before-and-after designs. Findings from this study are offered in relation to the perspectives of the three participant groups in the placement: students, tutors and service users/carers. The paper goes on to discuss these findings and to draw conclusions for community-based IPE.     

1969 revisited: reflections on Tomorrow's community physician.

This lecture focuses on a paper that Jerry Morris published in the Lancet of Saturday 18 October 1969 entitled Tomorrow's Community Physician. It was a seminal paper in which a vision of the role and potential of a new breed of public health practitioner was set out. The themes raised in the original paper which examined population health and health service issues, are revisited, by assessing how things have changed, and in particular examining the extent to which the vision set out in the paper has become reality over the last 30 years.     

Dependence and identity: nurses and chronic conditions in a primary care setting

PURPOSE: This paper aims to explore the ways in which practice nurses engage in identity work in the context of chronic disease management in primary care and assess the extent to which this is compatible with the identities promoted in government policy. DESIGN/METHODOLOGY/APPROACH: The paper draws on qualitative interviews with nurses applying the concepts of "identity threat" and Hegel's Master-Slave dialectic to explore the implications of nurse-patient interdependence for identity in a policy context which aims to promote self-management and patient empowerment. FINDINGS: The nurses in the study showed little sign of adapting their identities in line with government policies intended to empower health care "consumers". Instead, various aspects of identity work were identified which can be seen as helping to defend against identity threat and maintain and reproduce the traditional order. PRACTICAL IMPLICATIONS: The paper provides information on barriers to self-management that are likely to inhibit the implementation of government policy. ORIGINALITY/VALUE: Whilst much has been written on the extent to which patients are dependent on health professionals, the issue of professional dependence on patients has received much less attention. The paper hightlights how viewing the nurse-patient relationship in the context of a struggle for mastery related to identity represents a departure from traditional approaches and sheds light on hitherto unexplored barriers to self-management.     

模糊理论在预防医学试卷分析中的应用与评价

摘要:目的　探讨模糊理论在预防医学试卷分析中的应用及效果评价。方法　从滨州医学院2011级临床、护理、口腔等医学专业35个班的2 346份预防医学试卷中,每班随机抽取1个组试卷共213份,运用模糊理论的权重方法对成绩加权处理,再随机抽取15份试卷分析并绘制S-P表和模糊S-P表。结果　在预防医学试卷分析中运用模糊理论,学生成绩分布更合理,成绩分析结果更准确和直观,并能改进试题质量和针对学生因材施教。结论　模糊理论屏蔽了试题结构对学生成绩分布的影响,优化了试卷分析结果,为教师提供了更准确、合理和直观的反馈信息。     

基于体素的投影算法的研究与实现

在体绘制算法中,本文提出了基于体素的投影算法,将不透明度参数引入绘制过程,得到具有半透明效果的三维图像。本文综合和吸收了体绘制技术的新成果,在PC机上基本实现了医学图像的三维重建,具有广阔的应用前景。     

Ethnicity and health: a research review

This paper is part of a larger piece of research on the perceptions of health and health services by members of the black population in North and East London, funded by the SSRC. The paper concentrates on published research produced principally by the medical profession and which concerns the health of 'immigrants', 'Asians', 'Afro-Caribbeans', 'members of ethnic minorities' or 'black people' in Britain. In five sections, the paper focuses on the illnesses and diseases which have been most intensively investigated and documented by previous researchers, and attempts to uncover the biases and/or assumptions that have led to this concentration on a few topics and groups at the expense of others. An attempt is also made to consider the influence of some of the findings of 'race relations' research on the health of Britain's black and ethnic minority population.     

Grandparents and grandchildren: a grand connection

This paper analyses the literature available on the contribution of grandparents to society and the synergies that develop between grandparents and grandchildren, which are increasingly important to families and the individuals involved. The paper interrogates the need for those who are ageing to find goals in life that are life affirming and the way in which grandparenting is contributing to social capital.     

Narrative learning, EAL and metacognitive development

This paper elaborates some aspects of narrative learning—defined here as learning to tell stories and learning from, about and through narratives—in the context of primary-age pupils who use English as an Additional Language (EAL). The paper introduces some principles to support their language development in classroom interaction. We argue that linguistically orientated research on metacognitive strategy development is not necessarily readily applied to EAL learners. After presenting a background on narrative, narrative development and social aspects of telling stories, we introduce an approach to narrative development which encourages a cycle telling and retelling of stories which provides EAL learners with layered opportunities for developing the metacognitive features of planning, remembering, understanding and reflecting on storytelling. This is enabled through the use of written 'keywords', which are used in conjunction with 'story maps' (which outline the narrative structure and content) together with classroom photos. While the focus of the paper is on EAL learners, the visual approach described here can be used with narrative (or factual information) for many other young children and has been used by speech and language therapists to develop specific aspects of language for speech and language impaired children.