《军队医院成本核算信息管理系统》对医院经济管理的作用

随着《军队医院成本核算信息管理系统》的顺利实施,我院在经济管理方面发生了很大变化。本文主要从几个方面阐述了《军队医院成本核算信息管理系统》对经济管理的作用和影响,并总结了新形势下经济管理亟待解决的问题。     

The dietary management of diabetes in adults.

The ultimate object of all types of dietary management before the introduction of insulin was to prevent emaciation and death: the consequences of metabolic derangements due to lack of insulin. Now, while dietary therapy continues to be important in minimizing the requirement for endogenous insulin or in balancing administered insulin, the major objects are changing to prevention of large vessel and microvascular disease. The next decade will probably see a more widespread introduction of diets containing a lower proportion of energy derived from fat. The increased carbohydrate intake will almost inevitably result in increased dietary fibre intake. Whether David Jenkins' Lente carbohydrate foods (those containing viscous unabsorbable polysaccharides) will prove to be of lasting value is not yet known. Since galactomannans occur in legumes perhaps we should consider the possibility of diets containing large proportions of legumes: a twentieth century 'Legume cure'? If this should prove of value it would not have excited ancient Indian physicians who wrote (in the Caraka-Samita) of their use of legumes in the treatment of glycosuria, at least as early as the first century AD, before Aretaeus had applied the term diabetes.     

医用设备的成本管理和成本控制

现代科学技术的成果在医学领域的广泛应用，为人类生存条件的改善和生活质量的提高作出了巨大贡献，但同时也导致了医疗费用的高速上涨。大型医用设备是现代高新技术的突出代表，我国医疗机构在其引进和使用中同样存在着因盲目购置和不合理使用而造成卫生资源浪费的现象。在目前卫生体制改革的背景下，加强对医用设备的成本管理和成本控制，通过控制初始投资规模；合理配置资源和提高设备利用率来提高投资的经济性是非常必要和迫切的。     

The direct medical cost of diabetes in Israel

Diabetes mellitus is an important chronic disease with a growing prevalence that absorbs an ever increasing investment of resources. This population-based study evaluated the direct medical costs of diabetes mellitus in an HMO setting. We evaluated both the total cost of diabetic patients and their added cost in comparison to other HMO members (diabetes-related costs). Data were obtained for the years 1999–2001 in a cohort of 24,632 diabetic patients followed up for 3 years drawn from the computerized medical administrative database of a large HMO in Israel, insuring around 25% of the population . The mean direct cost of the medical treatment of a diabetic patient rose 29% from US 2,017 in 1999 to2,017 in 1999 to 2,601 in 2001 (in 2001 terms) in comparison to a 19.7% rise (from 1,246 to1,246 to 1,492). Hospitalizations, medication, and physician visits account for 39%, 29%, and 21% of the total diabetic patient costs, respectively. Dialysis, insulin intake, impaired creatinine, and elevated HbA1c were associated with increased expenditures. According to our results, the total national medical cost of diabetes alone in 2001 was 317 million and that of diabetic patients was317 million and that of diabetic patients was 564 million, 6.9% and 12.4% of the total Israeli HMO budget, respectively. The study presents the use of a population-based computerized database to comprehensively assess the economic burden of disease and the potential savings from prevention. The study data suggest a rise in the cost of diabetes which has implications for prevention and treatment policies.     

深圳市社区高血压和糖尿病健康管理服务成本研究及预测

目的测算社区高血压和糖尿病健康管理服务成本,为社区慢性病患者健康管理服务经费预算及强化管理提供科学依据。方法通过文献研究及专题讨论建立备选指标库;经两轮德尔菲法专家咨询,确定慢性病患者健康管理服务标准项目内容及工作步骤;随机抽取60家社区健康服务中心(以下简称"社康中心")进行现场调查,测定慢性病患者健康管理服务的工作时间、2013年服务量等。结果慢性病患者健康管理服务包括3大类别,18项服务内容及54条工作步骤。60家社康中心2013年慢性病患者健康管理服务调整工作时间合计174 664.9 h。按调查社康中心、全市社康中心、基层专业公共卫生机构当年的在编人员平均收入水平和专家建议人力成本价格得出慢性病患者健康管理服务总成本分别为1 447.5万元、1 465.0万元、1 639.7万元和1 878.9万元;人均成本分别为13.7、13.9、15.5和17.8元/人年;规范管理1名高血压患者的单位成本分别为370.2~480.6元/人年;规范管理1名糖尿病患者的单位成本为372.1~483.0元/人年。预测2015年深圳市社区慢性病患者健康管理服务若要达到国家规范标准中档目标,所需人均成本为28.3~36.7元/人年,若要完全达到国家标准目标至少需45.1元/人年。结论政府需加大对社区慢性病患者健康管理服务的经费投入,以保证慢性病患者健康管理工作的顺利开展。     

医院成本管理的实践与探讨

新医改政策陆续实施后,必须加强医院的内部成本核算管理,使医院在医疗市场中更具竞争力,这也是医院扩展生存空间和进一步发展所必须的,而且医院要在把社会效益放在首位的前提下,兼顾经济效益。目前医院成本管理正由经验型、粗放型向科学型和质量效益型转变。     

The information imperative of outcomes management

Health care providers are being asked to collect, analyze, and evaluate the results of medical processes or procedures to improve the outcome of health care services. The linkage of process to outcome is not a new science, but it has assumed greater importance in today's health care economic climate. Medical effectiveness and outcomes management studies, once within the purview of health services investigators, are moving to the individual provider setting. This evolution has tremendous impact on health information management professionals. As the guardians of the data that are indispensable for medical effectiveness and outcomes management investigations, health information management professionals play a key role in caregivers' attempts to correlate process and outcome performance measures. The article discusses the historical origins of outcomes management, the prominence of outcomes management in health care reform activities, and the responsibilities of health information management professionals in these strategic initiatives.     

The cost of diabetes in Latin America and the Caribbean

OBJECTIVE: To measure the economic burden associated with diabetes mellitus in Latin America and the Caribbean. METHODS: Prevalence estimates of diabetes for the year 2000 were used to calculated direct and indirect costs of diabetes mellitus. Direct costs included costs due to drugs, hospitalizations, consultations and management of complications. The human capital approach was used to calculate indirect costs and included calculations of forgone earnings due to premature mortality and disability attributed to diabetes mellitus. Mortality and disability attributed to causes other than diabetes were subtracted from estimates to consider only the excess burden due to diabetes. A 3% discount rate was used to convert future earnings to current value. FINDINGS: The annual number of deaths in 2000 caused by diabetes mellitus was estimated at 339,035. This represented a loss of 757,096 discounted years of productive life among persons younger than 65 years (> billion US dollars). Permanent disability caused a loss of 12,699,087 years and over 50 billion US dollars, and temporary disability caused a loss of 136,701 years in the working population and over 763 million US dollars. Costs associated with insulin and oral medications were 4720 million US dollars, hospitalizations 1012 million US dollars, consultations 2508 million US dollars and care for complications 2,480 million US dollars. The total annual cost associated with diabetes was estimated as 65,216 million US dollars (direct 10,721 US dollars; indirect 54,496 US dollars). CONCLUSION: Despite limitations of the data, diabetes imposes a high economic burden to individuals and society in all countries and to Latin American and the Caribbean as whole.     

The cost management organization: the next step for materiel management

With Materiel Management's transition over the last decade from simple logistics to analysis and cost management, it has gained recognition as a key part of the management team responsible for supplies, equipment, standards, and associated processes to identify, purchase, store, distribute, issue, and dispose of supplies and equipment. The materiel manager's job consists of putting the right product in the right place at the right time and in the right quantity at the best total delivered cost. In this context, Materiel Management has made powerful impacts to lower costs associated with: Distribution--costs have been lowered by actively adopting advanced supply channel management techniques such as primary suppliers, JIT, stockless programs, case cart/custom kit/procedure based delivery systems, modified stockless programs as well as margin management through cost plus, flat fee, or margins paid per activity. Cost of goods--lowered through aggregated purchasing in the forms of regional and national purchasing alliances and local capitation or other gain/risk share programs. Internal process costs--lowered by out-sourcing and/or integrating supplier processes and personnel into operations via partnership approaches. We have also reduced transactional costs through EDI transaction sets and the emerging use of the inter and intranet/electronic commerce, procurement cards, and evaluated receipt settlement processes. De-layering--We have lowered the operating costs of Materiel Management overhead by re-design/re-engineering, resulting in reduced management and greater front line authority. Quality--We have learned to identify and respond to customer and supplier needs by using quality improvement tools and ongoing measurement and monitoring techniques. Through this we have identified the waste of non-beneficial products and services. We have adopted supplier certification measurers to ensure quality is built into processes and outcomes. With so much already accomplished, it should be easy to rest on these laurels and simply operate. However, we believe that this is just a beginning. A new generation of highly educated leaders are emerging and taking advantage of the contributions of pioneers who laid the ground work. These new leaders will have advanced management, statistics, and behavioral sciences skills. They will be analysts and organizational motivators. Their goal will be to improve financial and clinical performance measured by real time process and performance data. The new leaders will have information at their fingertips thanks to significant leaps forward in data collection, automated continuous replenishment processes, and software designed for better management of clinical and cost outcomes. This article documents significant Materiel management accomplishments and conceptualizes cost management processes. The cost management organization is the logical evolution in our efforts for better outcomes in healthcare Materiel management.     

加强医院编外合同制收费人员管理

目前,在医院收费人员队伍中,存在大量的编外合同制工作人员.由于用工形式不同,合同制收费人员在劳动报酬、福利待遇、培训等方面与正式工存在一定的差别.如何加强管理,使其更好地服务于医院大局,仍是值得探讨的话题,本文结合我院现状,谈几点对医院合同制收费人员管理的思考.     

The integrated inpatient management model's clinical management information system

The rising cost of health care has increased the call for cost control. The pressing need to control cost, coupled with the increase in managed care and prospective payment, has placed new urgency on administrators and clinicians to work collaboratively in providing efficient and effective care. We have developed the Integrated Inpatient Management Model (IIMM) to assist in this collaborative effort. We describe the IIMM's clinical information system that provides decision support to both administrators and clinicians. This clinical information system is the information backbone for the development and monitoring of practice guidelines or critical pathways. An integrated information system of this type is essential if hospitals are to prosper during the next decade.     

医疗设备信息管理系统

本文介绍了计算机在医疗设备管理中的应用，按照医疗设备的具体特点，以模块形式分别制程序，利用计算机网络数据交换方便快捷地特性实现资产管理、科这致主设备效益分析。     

医疗设备管理信息系统的设计

本文介绍了医疗设备管理信息系统的开发和应用，按照医疗设备的具体特点，运用系统设计的思想进行设计。本系统能对医疗设备的各种信息方便地进行各种操作，并具有良好的人机交互能力。     

医院信息化建设工程的项目管理策略

针对医院信息化建设工程中的常见问题,运用信息系统项目管理的理论和方法,从医院信息化建设的总体思路;建设模式;业务流程的优化原则;加强范围管理,控制需求蔓延;采用科学的沟通方式,提高项目干系人的参与积极性;强化风险意识,建立风险管理计划,采取有效的风险应对策略等方面,进行了详细的阐述。并且明确指出在医院信息化建设中,只有采用科学的项目管理方法,才能提高项目建设绩效,取得信息化建设的最终成功。     

计算机信息管理系统在医院中的应用

医院信息管理系统是医院现代化的重要步骤和手段。结合本单位的实际情况，介绍了医院管理信息系统及实施过程中的体会。