谈医疗机构"医药分开核算、分别管理"

医疗机构实行“医药分开核算、分别管理”,旨在规范医疗行为,促进医疗机构收入结构的调整,优化医疗机构补偿机制,控制医院医药费用过快增长,降低药品收入在医院收入中的比重,促使医疗机构为群众提供质优、价廉的医疗服务。 医疗机构实行“医药分开核算”就是按照新的《医院会计制度》(以下简称《制度》),对医疗成本和药品成本分别核算。医疗服务和药品经销各项直接费用,要分别列入医疗支出和药品支出。医疗机构的管理费用,要按《制度》要求合理分摊到医疗成本和药品成本。要依照有关规定严格控制费用支出?严禁乱摊费用、扩大成本。 医疗机构要实行医药分别管理,笔者认为应实行“核定收     

实行"医药分开核算、分别管理"应解决的几个问题

实行“医药分开核算、分别管理”是《中共中央、国务院关于卫生改革与发展的决定》的一项主要内容。日前,由国务院体改办等八部门共同制定的《关于城镇医药卫生体制改革的指导意见》,对这一问题在现阶段的实施又作了进一步的规定:“实行医药分开核算、分别管理。……可先对医院药品收入实际收支两条线管理,药品收支结余全部上缴卫生行政部门,纳入财政专户管理,合理返还,……。”那么,在现阶段怎样才能真正落实“医药分开核算、分别管理”,达到降低患者负担的目的呢?笔者认为首先应解决好以下几个问题: 1 解放思想,更新观念,增强医药卫生体制改革的紧迫感 1.1 在当前的医院业务收入中,药品收入所占比例过大     

浅谈对医药分开核算、分别管理的思考

背景 20世纪90年代，医疗费用持续增长，超过GNP的增长速度。医疗费用上升中药品费用占很大比重。原因分析 医疗财政补偿持续不足，药品市场管理混乱，卫生系统的行业形象下降，社会要求卫生系统进行改革，为了解决药品费用上涨过快的问题，卫生部门尝试医药分开核算、分别管理政策。讨论 医药分开核算、分别管理不同于医药分业，也不等于医药分家。政策实行后有引发许多新的问题：（1）医院补偿依然乏力；（2）病人的负担有增无减；（3）医疗质量保证难度加大等等。因此首先必须加强领导组织协调。     

医药分开医院如何应变

《中共中央、国务院关于卫生改革与发展的决定》明确指出:“调整医疗机构收入结构,降低药品收入在医疗机构收入中的比重,合理控制医药费的增长速度。医疗收支和药品收支实行分开核算、分别管理。”现就这一政策,谈一下自己的认识,愿与同道商榷。 1 医药分开核算的背景 改革开放20年来,医药费持续上涨,“看病贵”已呈普遍现象。“大处方”,卖贵药是造成医药费上涨的重要因素之一。实行“医药分开”有利于规范医     

"核定收入、超收上缴"与"结余上交、合理返还"的分析评价

《中共中央、国务院关于卫生改革与发展的决定》指出,要调整医疗单位收入结构,降低药品收入在业务收入中的比重,合理控制医药费用增长幅度,医疗收入和药品收入实行分开核算、分别管理。为落实药品资金管理的决定,卫生部与财政部先后出台两个药品资金管理办法:一是《医院会计制度》,要求医院药品资金实行“核定收入、超收上缴”的管理办法;二是《医院药品收支两条线管理暂行办法》,规定医院药品收支结余上交卫生部门,统一缴存财政社会保险基金专户,经考核后,统筹安排,合理返回。医药     

医药分开核算分别管理改革的目标及政策选择

文章指出医药分开核算分别管理改革应确定两大目标：控制医药费过快上涨;逐步完善医疗机构补偿机制。提出应推行五大改革措施：控制药品收入;控制平均医疗、住院费用增长幅度;药品收入定比例上缴;大型医疗设备收费降低10％;强化药品采购管理。     

医疗机构医药"分开核算、分别管理"实施之我见

继新的《医院财务制度》、《医院会计制度》提出对医疗机构实行医药“分开核算、分别管理”的政策之后,国务院办公厅转发的国务院体改办等八部门共同制定的《关于城镇医药卫生体制改革的指导意见》以下简称《指导意见》),再次强调了医疗机构实行医药“分开核算、分别管理’的现实性和紧迫性,并赋予了医药“分开核算、分别管理”新的含义和内容。那么,怎样认识和理解《指导意见》中关于医疗机构实行医药“分开核算、分别管理”的意义和内涵?笔者认为,应从以下几个方面理解和把握。     

对医院药品实行“收支两条线”管理的看法

为抑制医院药品收入的过快增长 ,１９９９年度实行的新《医院财务制度》提出了医疗机构实行医药“分开核算 ,分别管理”和药品“核定收入 ,超收上缴”的管理办法 ,从制度上提出了限制医院药品收入的管理办法 ,其目的就在于抑制医药费用的过快增长 ;最近 ,卫生部、财政部又印发了《医院药品收支两条线管理暂行办法》 ,提出对医院的“药品收支结余上交 ,合理返还”的管理办法 ,进一步加大了控制医疗机构药品费用增长过快的力度。笔者就此提几点看法。一、医院药品收支结余上交是手段 ,降低医药费用才是目的医院的收入主要有医疗技术劳务收入、…     

医药分开核算分别管理后药剂科工作的探讨

医药分开核算、分别管理是指对医疗机构的医疗收入、药品收入按照新的财务会计制度严格区分、单独核算,并对药品收入实行“核定收入,超收上缴”的管理办法,医院药剂科面对这一改革引发的诸多问题,必须采取相应的对策措施,以顺应这一新的管理模式。一、存在问题１．药剂人员思想活跃、认识不统一：近年来医药分业作为医院管理制度改革的热门话题,为医药界人士及公众众说纷云。特别是有人提出“把药剂科（药房）从医院彻底地、完全地分离出去,使之归医药公司管理”的论点在尚未公开澄清的情况下使得许多药剂人员把医药分开核算、分别管…     

对医药"分开核算、分别管理"几个问题的探析

《关于城镇医药卫生体制改革的指导意见》(以下简称《指导意见》)指出实行医药分开核算、分别管理。那么 ,这项改革将会对社会产生什么样的影响 ?虚高的药品价格能否降下来 ?医院今后应该如何生存和发展 ?本文试图对这些问题进行分析和探讨。一、医药分开后 ,虚高的药价有望降下来近些年 ,由于国家缺乏对医药工业的全面干预和调控 ,使得医药工业盲目发展 ,药品产量急剧增加 ,从而形成供过于求的局面。但药品流通体制的混乱以及医院、医生热衷于追逐经济利益 ,使得药品价格居高不下 ,严重违背了价值规律。药品费用增长似乎成了一个不可治愈的…     

Care-seeking behavior for upper respiratory infections

BACKGROUND: Many recent efforts to reduce unnecessary medical services have targeted care of upper respiratory infections (URIs). We tested whether patients who seek care very early in their illness differ from those who seek care later and whether they might require a different approach to care. METHODS: We surveyed by telephone 257 adult patients and 249 parents of child patients who called or visited one of 3 primary care clinics within 10 days (adults) or 14 days (parents) of the onset of uncomplicated URI symptoms. Those who contacted the clinic within the first 2 days of illness were compared with those who made contact later. RESULTS: Although 28% of adults and 41% of parents contacted their clinic within the first 2 days of symptom onset, we found very few differences in the characteristics of the caller or patient between those who called early and later. The illnesses of those who called early were not more severe, and they did not have different beliefs, histories, approaches to medical care, or needs. The only clinician-relevant difference was that adult patients calling in the first 2 days had a greater desire to rule out complications (84.7% vs 64.1% calling in 3-5 days and 70.6% calling after 5 days of illness, P < or = .05). CONCLUSIONS: Those who seek medical care very early for a URI do not appear to be different in clinically important ways. If we are going to reduce overuse of medical care and antibiotics for URIs, clinical trials of more effective and efficient strategies are needed to encourage home care and self-management.     

异位妊娠保守治疗105例临床分析

目的探讨异位妊娠保守治疗中药物治疗及期待治疗两种方案的效果。方法取符合保守治疗条件的异位妊娠患者105例为研究对象,并根据具体情况分为用药组及非用药组,用药组给予MTX或米非司酮治疗。观察两组患者的临床征象、并对手术率、血β-HCG降至正常天数及住院时间等进行比较。结果研究对象中91例保守成功,成功率86.7%;两组手术率、血β-HCG降至正常天数及住院时间差异无显著性(P>0.05)。结论MTX对血β-HCG水平较高的异位妊娠患者有使用价值,对血β-HCG较低者可期待疗法,米非司酮可在血β-HCG中等水平使用。异位妊娠应避免过度治疗。     

An optimal contract approach to hospital financing

Existing models of hospital financing advocate mixed schemes which include both lump-sum and cost-based payments. The doctor is generally the unique decision maker, which is unrealistic in a hospital setting where both managers and doctors are involved. This paper develops a model in which managers and doctors are responsible for different decisions within the hospital. In this model, public authorities who provide the financing, hospital managers who allocate resources within the hospital, and doctors who assign patients to either a low-tech or a high-tech therapy have information of increasing quality on the casemix of patients. The public authorities sign with hospital managers contracts specifying some lump-sum financing and some size of a high-tech equipment. In turn, managers, who know the broad mix of patients in the hospital, sign with hospital doctors contracts that specify the non-medical resources allocated to this facility as well as some remuneration. Doctors, who know each patient's illness severity, select the patients to be treated by the high-tech facility, and receive from public authorities some fee-for-service payment that is differentiated according to the low- or high-tech treatment used for curing their patients. What emerges is a two-stage agency problem in which contracts are designed to elicit information in the most efficient way.     

Long wait for angiography increases patient risk

KEY POINTS Despite an explosion in the number of cardiac catheterizations being performed today, patients who rely on public assistance may have to wait for an angiogram if they are unable to pay on their own. A Texas study of patients in a state-owned hospital reports that after two weeks on a waiting list for angiography, the risk of cardiac events and hospitalization rises. When patients are placed on a waiting list, priority should be given to those who have strongly positive stress tests or who take two or three different medications for ischemic heart disease.     

The undisciplined patient in neoliberal society: conscious,informed and intuitive health behaviours

Applying Foucault’s theoretical concept of discipline, the present article uses the term undisciplined patients to describe those who resist medical authority, defy conventional medical interpretations concerning health risks and adopt non-normative health behaviours. There is considerable scholarly literature available on non-normative health behaviours, such as out-of-hospital birth, refusal to vaccinate or homoeopathy. While differentiating each such issue from the others has its merits, we argue that these health behaviours have much in common and ought to be perceived as a social phenomenon characteristic of Western neoliberal societies, in which health consumers are expected to assume responsibility for their own health behaviours and to avoid health risks. The objective of the research on which this article is based was to explore the common attitudes underlying the health behaviours of undisciplined patients, or, using Foucault’s terminology, determining which technologies of the self they implemented. We conducted in-depth interviews with 10 Jewish Israeli undisciplined patients during 2016. We identified four different practices that undisciplined patients implement: critical awareness of the medical hegemony; willingness to challenge by asking questions, collecting information and involvement in a continuous process of inquiry; using intuition in making health-related decisions and possessing a powerful internal locus of control; and willingness to control their fear and anxiety. Their health behaviours varied widely, including non-normative and normative practises alike, rendering it impossible to address them as one coherent discipline. Situating the social phenomenon of undisciplined patients is of importance to researchers who study risk, as well as to health policy experts. It will also benefit those who study specific non-normative health attitudes and behaviours.     

冠心病合并2型糖尿病患者冠状动脉造影分析

目的探讨冠心病合并2型糖尿病患者的冠状动脉（冠脉）造影特点。方法716例冠心病患者，均行冠脉造影检查。其中冠心病合并2型糖尿病患者340例作为观察组，冠心病不合并2型糖尿病患者376例作为对照组。对两组患者的冠脉造影资料进行分析。结果观察组多支病变高于对照组（56．2％比34．6％，P〈0．05），C型病变高于对照组（54．1％比24．5％，P〈0．05）。结论冠心病合并2型糖尿病患者冠脉病变广泛且复杂。     

Obstetrics and Gynecology Practices and Patient Insurance Type

BackgroundDespite research on health disparities based on insurance status, little is known about the differences in practice patterns among physicians who cater to privately and non-privately insured patients. The aim of this study was to assess how obstetrician–gynecologists (ob-gyns) who primarily see patients with private insurance differ from those who see mainly uninsured or publicly insured patients. This could be informative of the needs of these two groups of physicians and patients.MethodsA questionnaire was mailed or emailed to 1,000 members of the American College of Obstetricians and Gynecologists, 600 of whom participate in the Collaborative Ambulatory Research Network.FindingsA 56.4% response rate was obtained. Of the valid responders, the 335 reported providing care to a majority of patients with private insurance (“private group”) and the 105 reported providing care to mostly publicly insured or uninsured patients (“non-private group”) were included in our analyses. Differences between groups included that the private group was more likely to see patients before their becoming pregnant and spent more time on well-woman care. The private group was more likely to see patients who are White, Asian, or between the ages of 45 and 64. The non-private group was more likely to see Hispanic patients and those under age 18.ConclusionResults reveal that ob-gyns who see mostly privately insured patients have different clinical experiences than those who see mainly uninsured or publicly insured patients in terms of patient characteristics, preconception care, distribution of time on activities, and the of likelihood performing certain procedures and screening tests.     

1075例产前诊断胎儿染色体核型分析

目的:探讨因不同指征行产前诊断的孕妇中胎儿染色体异常的类型及出现频率。方法:回顾性分析2004年10月~2009年8月在广西壮族自治区人民医院因各种原因行羊膜腔穿刺或脐带血穿刺产前诊断的胎儿染色体核型。结果:1 075例产前诊断中发现胎儿染色体异常32例,染色体异常检出率2.97%。其中因唐氏综合征高危行产前诊断者中胎儿染色体异常检出率1.82%;因高龄行产前诊断者中胎儿染色体异常检出率1.82%;因18、13-三体筛查高危行产前诊断者染色体异常检出率1.35%;因畸胎史行产前诊断者中胎儿染色体异常检出率2.70%;因孕早期用胚胎毒性药物行产前诊断者中胎儿染色体异常检出率2.77%;因有自然流产史或本次妊娠有先兆流产而行产前诊断者中胎儿染色体异常检出率均为0;因孕11~14周B超检查示NT值大于2.5 mm行产前诊断者中胎儿染色体异常检出率5.41%;因B超检查示羊水少、胎儿单脐动脉、心室强光斑、胎儿肾盂分离行产前诊断者胎儿染色体异常检出率7.14%;因生育过唐氏综合征患儿行产前诊断者胎儿染色体异常检出率25.00%;因夫妻双方之一为染色体平衡易位行产前诊断者中胎儿染色体异常检出率88.89%;因有生育重型地中海贫血患儿风险行产前诊断者胎儿染色体异常检出率1.35%。结论:除夫妻双方之一为染色体平衡易位及生育过唐氏综合征患儿者外,B超检查示羊水少、胎儿单脐动脉、心室强光斑、胎儿肾盂分离的胎儿中染色体异常检出率高,其次为NT值大于2.5 mm的胎儿,再次为孕早期用胚胎毒性药物、因畸胎史行产前诊断者、孕妇高龄及唐氏综合征高危。孕中期胎儿系统的B超检查,孕11~14周B超测NT值及孕中期血清学唐氏综合征筛查可以从人群中筛查出染色体异常高危胎儿,提高产前诊断的效率,减少出生缺陷儿。     

The incidence of Cyclospora cayetanensis in stool samples submitted to a district general hospital.

Cyclospora cayetanensis is the cause of a prolonged diarrhoeal syndrome. In the UK most cases are seen in travellers who have returned from countries in which the organism is endemic. The purpose of this investigation was to determine the incidence of C. cayetanensis in stool samples submitted to a district general hospital. A total of 6151 stools from 5374 different patients were screened for the presence of C. cayetanensis over a 1-year period using the modified Ziehl-Neelsen technique. Oocysts of C. cayetanensis were found in 7 stools (0.1%) from 4 patients (0.07%). All four patients were adult travellers who had visited countries in which C. cayetanensis is known to be endemic. In the population of this study, C. cayetanensis was found to be a rare cause of diarrhoea. Although C. cayetanensis infection should be considered in individuals of all ages who have lived in, or have travelled to endemic areas, there is no need to screen stool samples for the organism in those without such a travel history.