基于价值链理论的医院结算支付流程再造

通过对医院现有结算支付方式的比较，总结了现有各种缴费载体的特点。针对日益普及的手机支付方式，统计分析了使用手机APP缴费人群的年龄以及使用手机缴费的时间，为优化支付流程提供数据支撑。基于价值链理论，从内部价值链重构和外部价值链拓展两个方面，整合优化院内院外各项资源，进行医院医疗费用结算支付流程再造，使患者结算支付更加便捷，节约医院医疗资源，增加患者满意度。     

手机付款看病，“简约而不简单”

到友谊医院就诊，患者用一部手机就能完成挂号、交费等多个环节，免去反复排队之苦。该院也成为本市首家试水手机支付并支持医保报销的医院。 日前，友谊医院联合支付宝、东华软件共同推进“未来医院”计划，该院手机支付服务正式登录支付宝钱包服务窗。患者到友谊医院看病时，无需多次排队，在手机上即可完成挂号、交费、排号候诊等环节。     

移动支付在医院财务应用中存在的问题及对策

目的：探索规范移动支付管理的对策，以保障医院国有资产的安全。方法：基于某医院移动支付在财务中应用的现状，分析移动支付管理存在的问题。结果：医院的移动支付管理存在资金安全、财务对账、单边账、退费等问题。结论：移动支付的推广是大势所趋，在给医院和患者带来便利的同时，也使医院面临着诸多风险。医院必须采取措施积极应对，规范移动支付的管理，有效防范财务风险的发生。     

以患者为中心 科学构建 “银医通” 服务平台

目的:探索建设一种以患者为中心的多银行共享平台实时结算"银医通"新模式。方法:通过创新银行和医院合作方式,搭建银行和医院实时结算平台,并以"互联网+"为基础,同时支持手机、网上银行等移动支付结算,患者全程自助服务,便捷快速支付,同时获得更多就医信息,改善就医体验。结果:新型"银医通"平台,多卡合一统一自助消费模式,以实名制实现信息互通,同时支持实时结算和远程支付,将医疗服务无限延伸,真正以患者为中心,方便人民群众就医,患者使用率高。结论:一个真正以患者为中心的"银医通"平台,才能让患者得方便,医院得效率,银行得资金,实现患者、医院、银行等多方共赢的目标。     

医保患者个人和统筹支付费用的影响因素分析

目的 了解天津市医保肝硬化住院患者个人支付和统筹支付费用的影响因素,探索降低住院费用的策略,为建立有效的费用控制机制提供依据.方法 从天津市2003～2007年医保住院患者资料库中抽取肝硬化患者2 341例,对其住院费用中的个人支付和统筹支付构成情况进行分析.组间比较采用秩和检验,用多元逐步回归方法对不同支付方式的影响因素进行分析.结果 影响两种支付方式费用的主要因素均有住院天数,医院类别和治疗方式,人员类别还影响个人支付费用.住院日越长,医院级别越高,手术治疗患者个人支付和统筹支付费用越高,在职人员个人支付费用高于退休人员.结论 政府、医院和医保机构各方面需协同努力,统一的诊疗常规基础之上考虑年龄、病情、治疗方式等因素而制定肝硬化的单病种收费标准,可以有效地降低肝硬化患者的个人及统筹支付费用.     

微信公众平台在医院的应用实践研究

用手机玩微信是时下很多人的一种流行时尚。如何利用医院的微信公众平台对医院的形象进行宣传和为患者群众提供预约挂号、检查结果及费用查询、缴费支付、在线咨询等便民服务,是当前很多医院关注的话题。广西壮族自治区人民医院结合当前全国医院正在开展的"进一步改善医疗服务行动计划"活动,在微信公众平台的应用实践方面开展了一些颇有成效的探索,进一步改善了患者的就医体验,提升了患者对医院的满意度,促进了医患和谐。     

统筹支付政策的改变对太原市居民医保恶性肿瘤患者住院治疗情况的影响

目的 本课题通过调查2010、2011年太原市居民医保恶性肿瘤患者住院费用情况,对比统筹支付政策的改变前后对太原市居民医保恶性肿瘤患者的住院治疗情况的影响.方法 采用回顾性调查研究方法,收集太原市2010、2011年度居民医保恶性肿瘤患者住院治疗人数、住院费用、统筹支付金额、自付金额等数据,分析统筹支付政策的改变对太原市居民医保恶性肿瘤患者住院治疗情况的影响.2010、2011年度太原市居民医保恶性肿瘤患者住院人数、费用总额、统筹支付金额及比例总体呈上升趋势,自付比例总体呈下降趋势.结果 统筹支付政策的改变,明显的增加了各级医院居民医保恶性肿瘤患者住院治疗的人数,且三级医院增长率明显高于二级医院;在各级医院,统筹支付金额及其在总的住院费用中所占比例也有了大幅度的提高,尤其是在三级医院;患者统筹支付金额、自付金额及自费金额均有所增加,其中统筹支付金额所占比例增幅较小,自付金额所占比例有所下降,自费金额所占比例略有增加.结论 统筹支付政策改变在提高居民医保恶性肿瘤患者的住院治疗率,减轻医保患者经济压力方面起到积极作用,应该进一步深化统筹支付政策的改革,进一步加大统筹支付的比例,降低居民医保恶性肿瘤患者的治疗压力.从宏观角度给政府医保部门提出建议和对策.     

各级医院牙科手机消毒状况调查

牙科手机是口腔科临床最常用的器械,它在治疗过程中密切接触患者唾液、血液、龈沟液和牙菌斑.因此,污染程度较高.卫生部<医院消毒技术规范>中明确规定临床使用后的牙科手机必须经灭菌处理.为了解目前牙科手机在临床的消毒状况,我们随机对北京市30家医院消毒后的牙科手机进行检测.报告如下.     

持续改进门诊预约诊疗服务的实践与思考

以中国医科大学附属盛京医院为例,介绍了该院近年来开展预约诊疗服务的做法,并针对预约诊疗服务存在的问题,提出推进新号源配置管理模式等改进办法。医院在探索预约诊疗服务方面特色鲜明,例如较早开展多种预约诊疗服务、手机APP支持当日挂号和手机支付等多个特色之处,并取得手机挂号利用率较高、医院整体预约率稳步提升等明显效果。     

血液净化中心医患咨询、随访互动平台在临床的应用

近年来,电信网络技术发展迅速,且电信业务的发展已由技术驱动发展模式向业务驱动发展模式转变,对于未来电信业务的研究已成为驱动电信网络建设及电信运营发展的动力源泉.发掘新的应用空间将有利于拓展电信业务新功能和范围.我院血液净化中心鉴于透析病人与医护人员有着一种长期依存、互助互通的关系,采用百易科技构建了医患咨询、随访互动平台,建立了一套让透析患者可以随时主动的咨询、求助、投诉或者提建议的沟通渠道.该互动平台是集合了软件技术、硬件技术、通讯技术:实现电脑(医院)-手机(患者)互动信息对话,并保存数据;实现手机(医生)-电脑(医院)-手机(患者)信息互动传输,以此提高医院的服务质量和扩大医院的服务范围,赢得患者的信任和依赖,给医院带来长远的社会和经济效益.     

我国公立医院医疗服务支付制度改革与发展的思考

医疗服务支付制度改革是深化医改的组成部分,我国将大力推行支付制度改革试点,逐步完善医疗服务的支付制度.本文在对当今的公立医院补偿机制以及与其密切相连的、按项目付费支付制度的负面作用产生的历史根源、理论根源进行分析研究的基础上,对公立医院的性质、公立医院的补偿机制的理论基础进行了论述.探讨了新形势下推行支付方式改革的原则和要点,提出了当前应以医疗服务支付制度改革为契机,将其与解决公立医院补偿机制顽疾紧密相连,把实现"控制费用、强化管理、确保质量、转换机制、实现多赢"作为支付制度改革的核心目标,将公立医院改革引向深入.     

试论公立医院公益性发挥与卫生财政转移支付制度改革

论述了卫生财政投入和卫生财政转移支付的现状,结合公立医院公益性的现状．分析了当前卫生投入存在的问题,提出了增强公立医院公益性的卫生财政转移支付的政策建议：制定财政转移支付制度的远景规划,调整卫生财政转移支付的模式,加大对地方财政转移支付力度,合理划分事权并明确财权,改进并优化卫生财政转移支付制度,从而为公立医院发挥公益性提供有力的财政保障。     

论三项改革联动和公立医院管理体制改革

文章从医院面临的问题入手,分析三项改革联动与公立医院管理体制改革的关系,继而分析包含管理管理体制改革在内的三项改革联动步骤,尤其是突破口。文章认为三项改革联动的突破口是：改革医院支付方式和补偿机制,变现有按服务项目支付为“总量控制与按服务量支付”,能形成医院主动追求“内涵发展”的政策环境和经营氛围。这在种环境下,医院只有成本最小化,方能达到自身收益最大化,三项改革联动的基本目的就有望一揽子解决。在此基础上,推导医院管理体制和机制改革的相关模型。     

A simple simulation model as a tool to assess alternative health care provider payment reform options in Vietnam

Vietnam is currently considering a revision of its 2008 Health Insurance Law, including the regulation of provider payment methods. This study uses a simple spreadsheet-based, micro-simulation model to analyse the potential impacts of different provider payment reform scenarios on resource allocation across health care providers in three provinces in Vietnam, as well as on the total expenditure of the provincial branches of the public health insurance agency (Provincial Social Security [PSS]). The results show that currently more than 50% of PSS spending is concentrated at the provincial level with less than half at the district level. There is also a high degree of financial risk on district hospitals with the current fund-holding arrangement. Results of the simulation model show that several alternative scenarios for provider payment reform could improve the current payment system by reducing the high financial risk currently borne by district hospitals without dramatically shifting the current level and distribution of PSS expenditure. The results of the simulation analysis provided an empirical basis for health policy-makers in Vietnam to assess different provider payment reform options and make decisions about new models to support health system objectives.     

DRG实施背景下公立医院高质量发展路径研究

作为守护居民健康最后“闸口”的公立医院,在满足DRG支付方式改革要求的基础上明确并契合高质量发展路径,是当前理论研究与实践探索的关键。本文紧扣公立医院运行的核心内容——医疗服务的全周期,从生产、分配、交换与消费四个环节重新梳理高质量发展的内涵;并从政策、经济、社会、技术维度识别DRG支付对公立医院运行的作用方式与作用内容。在此基础上,提出DRG支付背景下公立医院高质量发展路径：一是推动理念融合,明确公立医院发展内核;二是加强部门协作,提升公立医院管理效能;三是落实系统整合,实现资源共享与机构共生;四是促进回归服务,增强患者获得感。     

Much ado about nothing? The financial impact of physician-owned specialty hospitals

The U.S. hospital industry has recently witnessed a number of policy changes aimed at aligning hospital payments to costs and these can be traced to significant concerns regarding selection of profitable patients and procedures by physician-owned specialty hospitals. The policy responses to specialty hospitals have alternated between payment system reforms and outright moratoriums on hospital operations including one in the recently enacted Affordable Care Act. A key issue is whether physician-owned specialty hospitals pose financial strain on the larger group of general hospitals through cream-skimming of profitable patients, yet there is no study that conducts a systematic analysis relating such selection behavior by physician-owners to financial impacts within hospital markets. The current paper takes into account heterogeneity in specialty hospital behavior and finds some evidence of their adverse impact on profit margins of competitor hospitals, especially for-profit hospitals. There is also some evidence of hospital consolidation in response to competitive pressures by specialty hospitals. Overall, these findings underline the importance of the payment reforms aimed at correcting distortions in the reimbursement system that generate incentives for risk-selection among providers groups. The identification techniques will also inform empirical analysis on future data testing the efficacy of these payment reforms.     

“点数平衡法”在我国医院医疗收费方式中的应用研究初探

基于现有大型公立医院的医疗收费模式,结合新建大型公立医院运行机制,提出“点数平衡法”支付模式,探索“点数平衡法”在我国医院医疗收费方式中的应用,以期解决“看病贵、看病难”问题,保证医院和医务人员的正常收入和积极性。     

Insurance aspects of DRG outlier payments.

As part of the prospective payment system, the government pays 'outlier' payments for especially long or expensive cases. These payments can be viewed as insurance for the hospital against excessive losses. They mitigate problems of access and underprovision of care for the sickest patients, and provide additional payments to the hospitals that take care of them, thereby making payments to hospitals more equitable. This paper characterizes the outlier payment formulae that minimize risk for hospitals under any fixed constraints on the sum of outlier payments and minimum hospital coinsurance rate. We then simulate per-case payments for a policy that did not include any outlier payments, the current outlier policy, and several other policies that minimize risk subject to different coinsurance constraints. The current outlier policy achieves each of its goals to at least some extent, but more insurance could be provided without lessening attainment of the other goals. We also discuss some problems with the implementation of the current policy, such as its reliance on day outliers.     

Hospital reimbursement and capacity constraints: Evidence from orthopedic surgeries

Health care providers’ response to payment incentives may have consequences for both fiscal spending and patient health. This paper studies the effects of a change in the payment scheme for hospitals in Norway. In 2010, payments for patients discharged on the day of admission were substantially decreased, while payments for stays lasting longer than one day were increased. This gave hospitals incentives to shift patients from one-day stays to two-day stays, or to decrease the admission of one-day stays. I study hospital responses using two separate difference-in-differences estimation strategies, exploiting, first, the difference in price changes across diagnoses, and secondly, the difference in bed capacity across hospitals. Focusing on orthopedic patients, I find no evidence that hospitals respond to price changes, and capacity constraints do not appear to explain this finding. Results imply that the current payment policy yields little scope for policymakers to affect the health care spending and treatment choices.     

The Role of Critical Access Hospital Status in Mitigating the Effects of New Prospective Payment Systems Under Medicare

This article examines rural hospitals that potentially qualify as critical access hospitals (CAH) and identifies facilities at substantial financial risk as a result of Medicare's expansion of prospective payment systems (PPS) to nonacute settings. Using Health Care Financing Administration (HCFA) cost reports from the federal year ending Sept. 30, 1996, combined with county-level sociodemographic data from the Area Resource File (ARF), characteristics of potential CAHs were identified and their finances analyzed to determine whether they could benefit from the cost-based reimbursement rules applicable to CAH status. Rural hospitals were identified as potential CAHs if they met a combination of federal and state criteria for necessary providers. Rural facilities were classified as "at risk" if they had poor financial ratios in conjunction with high levels of dependence on outpatient, home-care or skilled nursing services. Almost 30 percent of all rural hospitals were identified as potential CAHs. Ninety percent of potential CAH facilities were identified as "at risk" by at least one of five possible risk criteria, and one-third were identified by at least three. Of those classified "at risk," 48 percent might not benefit from conversion to CAH because their inpatient Medicare reimbursement would likely be less under CAH payment rules than under their current PPS payment rules. Many potential CAHs were doing well under inpatient PPS because they were sole community hospitals (SCH) and were therefore eligible for special adjustments to the PPS rates. The Rural Hospital Flexibility Act would be more beneficial to the population of isolated rural hospitals if those eligible for both CAH and SCH status were given the option of retaining their SCH inpatient payment arrangements while still qualifying for outpatient cost-based reimbursement.