Does level of minority presence and hospital reimbursement policy influence hospital referral region health rankings in the United States

The shift from a fee‐for‐service payment to a value‐based payment scheme, sparked by the Patient Protection and Affordable Care Act, introduced pay‐for‐performance programs such Hospital Value Based Purchasing. Previous inquiry has not considered how local community factors may affect hospital system performance. This study investigated the association between local health performance and minority population in a hospital referral region (HRR). The primary objective was to ascertain whether community diversity levels are significantly associated to local health performance guided by the ecological model. Secondary data analysis collected from the 2016 American Hospital Association, Area Health Resource File, Commonwealth Fund Scorecard on Local Health System Performance, and the Dartmouth Atlas HRR dataset was used. Our primary findings show that the more diverse a HRR is, the more likely it is to be associated with lower ranking for access and affordability prevention and treatment avoidable hospital use and cost as well as healthy lives. Total performance score was significantly related to a better health ranking on prevention and treatment, hospital use, and cost, as well as healthy lives. This research supports the assertion that communities, particularly minorities in those communities, affect local health care performance in a variety of ways.     

医保制度对双诊制的影响及改革思路

双诊制是解决目前医疗系统许多问题的有效措施,具有重要的意义.我国的医疗保险制度经过多年的建设,对人民健康保障起到了重要的作用.该文章对双诊制的意义和现状进行了描述,分析了医疗保险政策对双诊制发展的影响,进而对医保制度如何促进双诊制发展提出对策建议以供决策者参考.     

The consumer welfare implications of the hospital ownership mix in the US: an exploratory study

This paper offers an empirical test concerning how hospital ownership mix affects consumer welfare in the US. The test compares the market benefits and costs resulting from an increased presence of nonprofit hospitals by observing empirically how the nonprofit market share impacts hospital care utilization at the margin. The empirical results suggest that too many not-for-profit and public hospitals exist in the inpatient care segment of the typical hospital services industry of the US. In contrast, the empirical findings indicate that too many for-profit hospitals operate in the outpatient care portion of the hospital services industry. The policy implication is that more quality of care per dollar might be obtained by promoting increased for-profit activity to inpatient care and more nonprofit activity to outpatient care in some market areas. This conclusion, however, is tempered with several caveats. We discuss these and also make recommendations for further research.     

深圳市院办院管模式下双向转诊问题分析与对策建议

通过社康中心工作人员问卷调查和关键知情人访谈,了解目前深圳市院办院管模式下双向转诊现状和影响双向转诊的因素,对双向转诊存在的问题进行了分析,针对性提出相关对策建议,为政府有关部门的决策提供参考。     

新医改形势下医院绩效评价的探讨——兼论美国“最好的医院”给我们的启示

随着《中共中央国务院关于深化医药卫生体制改革的意见》出台，公立医院改革作为5项重点改革内容之一，成为近期大众关注的焦点。而客观、公正地考核医院的整体绩效，从结构、过程和结果3方面利用适当的考核指标对医院绩效进行评价，是目前新形势下亟待解决的问题。在分析相关理论的基础上，借鉴美国最好的医院的评价方法，提出完善我国医院绩效评价的建议和需关注的问题。     

从经济学角度谈医院所有制改革的难点

论述了医院所有制改革的必然性和紧迫性。分析了医院所有制改革工作的重点和难点。明确了建立适应社会主义市场经济发展要求的医药卫生体制具有重要意义的改革目标。无论是在理论上 ,还是现实中都可以总结出 :对于我国 ,至少在很长一段时间内 ,公立医院应该占主导地位 ,为广大人民提供基本的医疗保障 ;而私立医院的服务及质量优势较为突出 ,只有当人们的生活水平达到较高的程度以后才能体现出来。     

Identifying occupational therapists' referral priorities in community health

Occupational therapists in British community mental health teams have been debating how the most effective services can be targeted at the most needy clients. This paper presents the results of a quantitative study that examined 40 British occupational therapists' referral prioritization policies. Results showed half of the participants felt their generic responsibilities, which involved having care co-ordination responsibilities, were too large. Only 25% of participants co-ordinated care for clients whose needs were related to occupational dysfunction. Judgement analysis, that involved regressing the 40 individuals' prioritization decisions onto the 90 respective referral scenarios, was used to statistically model how referral information had been weighted. Group agreement of prioritization was moderate with the reason for referral, history of violence and diagnosis being given the most weighting. Consistency in policy application, as measured by examining prioritization decisions on identical referrals, showed wide variability. Further research is required to identify the optimal and most stable policies within this group.     

Understanding referral from primary care clinics in rural Kenya: using health information systems to prioritize health services

This study analyses the referral patterns of patients, over time, from primary care to secondary or tertiary level facilities in rural Africa. The data come from a health information system of a non-governmental organization with a decade of experience in health services delivery in Samburu District, Kenya. The differential referral patterns from two communities are examined in some detail to shed more light on the meaning of a 'referral rate' in this context. First, referral rates over time for two clinics are calculated and compared. These quantitative data, obtained from monthly reports from 1989 to 1997, are interpreted in the light of qualitative data obtained from interviews with community health workers, nurses and members of the communities. The main differences in referral between these ostensibly similar communities are for malaria, trauma and anaemia. Social, environmental and specific health services factors are used to explain these differences. We demonstrate that basic information from health information systems, which tell us little on their own because referral in this context is a rare event, can be combined with local knowledge from the community to provide evidence for health managers to set priorities for public health and clinical interventions.     

Expansion in markets with decreasing demand-for-profits in the German hospital industry

Over the last 20 years, acute-care hospitals in most OECD countries have built up costly overcapacities. From the perspective of economic policy, it is desirable to know how hospitals of different ownership forms respond to changes in demand and are probably best suited to deal with existing overcapacities. This article examines ownership-specific differences in the responsiveness to changes in demand for hospital services in Germany between 1996 and 2006. With respect to the speed of adaptation to increasing demand, the study finds for-profit ownership to be superior to public and nonprofit ownership. However, contrary to other ownership types, for-profits also tend to expand in markets with decreasing demand - mainly through conversions of publicly owned hospitals. Thus, in short term, the privatization of the hospital sector may slow down the reduction of excess capacities and be therefore socially wasteful.     

公立医院与社区卫生服务机构双向转诊机制的探讨

目的探讨公立医院与社区卫生服务机构双向转诊机制,对中国目前的转诊机制提出对策和展望。方法对双向转诊的发展、现状进行了分析,总结了当前中国双向转诊所面临的困难、不足,结合德国、美国、英国在转诊方面的理论与实践方面的先进经验,通过查阅文献、实际调查、个别访谈等方法进行。结果公立医院与社区卫生服务机构双向转诊机制尚未有效建立,需要尽快形成共识,落实实施。结论公立医院与社区卫生服务机构转诊中出现的执行困难问题不是独立的卫生事件,而是一个综合性的社会问题。     

城市社区卫生服务发展机制的构建与运行——基于双向转诊制的功能实现

目前我国医疗资源分配存在一个重大的问题,即不同层级的医疗机构功能角色“错位”,缺乏合理分工,造成各地大医院“门庭若市”,社区医院“门可罗雀”的现象.要实现初级医疗服务和二级医疗服务的合理分工,发挥社区卫生服务的功能,核心在于建立和执行社区首诊制和双向转诊制,从机构、人才、投资、沟通、政策、转诊等角度构建社区卫生服务发展机制,从而实现合理利用医疗资源.     

美国和英国公立医疗机构公益性的相关经验

介绍了美国和英国公立医疗机构公益性的相关经验与做法,阐述了市场经济国家政府在其中发挥的作用。美国政府通过有限的公立医疗机构,构建卫生系统的“安全网”服务贫弱人群;英国政府则通过国家卫生服务和制度改革实现公益性和效率。美英的相关经验对我国制定确保医疗机构公益性相关政策具有一定的借鉴意义。     

应用病例分型原理构建双向转诊指标框架体系的探讨

目的:探讨应用病例分型原理构建规范合理、具备可操作性的新型双向转诊指标体系。方法:尝试在病例分型原理的基础上,通过文献检索等方法,筛选特征指标,初步构建双向转诊指标体系的框架。结论:双向转诊是新医改的关键节点之一,在基本医疗标准化建设的基础上,客观上需要制订一套规范的双向转诊实施和评估体系,以期有效推动新医改的战略规划。     

医药卫生体制改革对医院的影响及对策研究

医药卫生制改革将对医院产生巨大影响,医院必须深化改革：一是转变观念,解放思想;二是健全内部控制机制,强化自主管理;三是由外延发展向内涵发展转变;四是加强经营意识;五是深化人事制度改革;六是进行成本核算,深化分配制度改革。     

我国公立医院混合所有制可行性探讨

混合所有制经济"是基本经济制度的重要实现形式",但是作为向社会提供具有公益性医疗服务的公立医院,如何与社会力量合作,如何激励社会力量积极参与医疗服务,具有不同于其他行业的改革难度。本文围绕我国公立医院探索混合所有制过程中存在的问题展开讨论,认为公立医院不宜参考国有企业改革模式实施混合所有制,为解决公立医院数量过多和存在的治理及内部管理问题,可考虑社会化治理改革,将其转变为一种新型医院制度形式的特殊法人。     

北京市儿童心理保健双向转诊平台建设与实践

目的 充分整合利用基层和顶级临床儿科资源,建立北京市儿童心理保健双向转诊平台,为心理发育偏离和可疑行为问题儿童提供便利的全方位诊断和综合干预管理服务,达到理想康复效果.方法 利用北京市儿童心理保健双向转诊平台,以2018年11月9日至2019年12月31日期间全市16区儿童早期发展中心(儿早中心)上转的558例心理行为...     

A survey of refugee health assessments in the United States

We conducted a survey among nine geographically dispersed, large metropolitan refugee health programs to estimate the number of U.S. refugee arrivals during 1997 and 1998, the number receiving health assessments, and the percentage of sites offering health services. The nine sites received an estimated 40% of all U.S. refugee arrivals during the study period. Of these refugees, 76% received a health assessment. The completeness of health assessments, including services offered, varied by site; some services were provided by the private sector. Most sites offered services for infectious diseases and vaccinations. While 78% of the sites offered mental health care, but only 33% actually performed mental status examinations. These statistics show that such health services need to be provided on a broader basis and possibly reflect a need to address cultural and language barriers that might be preventing their delivery to this diverse population.     

中国的人口老龄化与区域经济增长

\t\t\t\t\t 目的 \t\t\t\t\t探索我国现代公共卫生医师的内涵,为建立健全公共卫生医师制度提供理论基础。\t\t\t\t\t\t\t\t\t\t\t\t\t 方法 \t\t\t\t\t以涉及“公共卫生医师”内涵的国内外相关文献和文件134篇以及46个相关权威网站作为研究对象,使用EXCEL 2016和SPSS 18. 0工具,运用共词分析法,建立公共卫生医师内涵的关键词共词矩阵并以此为基础进行多维尺度分析。\t\t\t\t\t\t\t\t\t\t\t\t\t 结果 \t\t\t\t\t基于共词矩阵的多维尺度分析结果显示stress = 0.203 90,RSQ = 0.798 86,现代公共卫生医师的概念较为复杂,主要体现在根本特征、角色定位、核心职能及准入要求四方面。\t\t\t\t\t\t\t\t\t\t\t\t\t 结论 \t\t\t\t\t我国现代公共卫生医师的内涵包括根本特征、角色定位、核心职能及准入要求4个维度,是一类以促进全民健康为目标的专业技术人员。\t\t\t\t     

国有医院成本核算与确定职工收入分配总量的研究

该着重研究国有医院成本核算与确定职工收入分配总量的问题。通过阐述国有医院财务管理与会计核算的目标、任务和要求，对国有医院业务经济管理现状作出性分析和客观性评价；重点介绍了有关国家和地区医院财务管理、成本控制做法和管理理念；在分析目前医院实施工资性支出管理办法的基础上，着重提出了确定国有医院职工收入分配总量的改革方案，以供探讨。