绩效支付体系的发展及其争议

绩效支付体系是一种把客外支付与绩效或贡献直接联系的支付方法，作一种科学管理手段出现于１９世纪末期。ＰＲＰ是在２０世纪８０年代末期从私立和其它公立部门引入到卫生部门的。目前ＰＲＰ已支付卫生服务管理者，医生、护士等。尽管如此，目前对ＰＲＰ的评价仍旧存有许多争论 。     

基层卫生、计划生育服务和管理及其在母婴保健服务中的作用

目的：研究卫生和计划生育2部门的资源拥有状况、服务提供状况以及在母婴保健服务中出现的矛盾和协调方式，为全面评价基层母婴保健工作及其管理提供参考意见。资料与方法：重庆市2个贫困县中6个乡镇的主管乡镇长为调查对象，采用结构式深入访谈方法收集定性资料。结果：乡镇政府干部对计划生育的管理及其投入精力显然比卫生管理更多，责任也更重要。卫生部门的人力和设备资源明显优于计划生育服务部门，但2部门具有不同的政府财政支持力度和方式。母婴保健服务主要是卫生部门提供，但2部门均提供一般性医疗服务，且在质量和价格上有所差别。2部门的矛盾主要体现在对基本医疗服务市场的竞争上。相关法律和政策已经比较明确地规定了部门的责任和协调方式，但对基本医疗服务方面缺乏更有效的协调手段。结论：2部门在卫生服务和计划生育服务方面各自发挥重要的作用，但计划生育部门提供的母婴保健服务应纳入卫生部门监督管理的范围。应强调计划生育部门提供的医疗服务应符合《医疗机构设置条例》的规定，并由卫生部门进行审批和考核。在适宜的条件下，试行基层卫生和计划生育服务的综合管理和机构整合。     

按绩效支付能否改善卫生服务质量——以英美“医院质量激励示范项目”为例

按绩效支付是依据卫生服务提供者的工作绩效对其进行支付的方式。这种支付方式强调卫生服务的质量和效率,因此在发达国家和地区得到越来越多的关注与实践。该文以在英国和美国开展的“医院质量激励示范项目”为例,介绍该项目的实施背景、绩效评价指标体系、激励机制以及绩效沟通与绩效改进措施,比较该项目在英美两国实施效果的异同,总结项目成功的经验和存在的问题,为按绩效支付在我国医疗机构绩效管理中的应用提供借鉴。     

强化疾控机构绩效考核意义的几点思考

<正>2010年,我省各级疾病预防控制机构(疾控机构)先后接受了上级卫生行政部门组织的第一轮绩效考核。卫生部疾病预防控制体系建设研究课题组编著的《疾病预防控制体系建设研究报告——绩效评估》一书认为,"疾病预防控制机构作为政府公共管理的重要部门之一,其绩效状况成为政府与社会关注的重点","如何科学评估疾病预防控制绩效也就成为政府和卫生部门亟待解决的问题"。据此     

我国中、西部县域卫生系统绩效评价框架

县域卫生系统是在县域内的,与居民健康相关的各个子系统组成的整体.是城乡卫生统筹建设的重点.我国中、西部县域卫生系统绩效评价框架以县域卫生总绩效目标为评价标准,由功能、中间目标和最终目标层面,结合卫生服务管理、服务提供、筹资与支付子系统等组成12个评价维度.评价框架从整体上反映了县城卫生系统的绩效,并重点关注农村基本卫生体系建设,对于推进中、西部县域卫生系统建设有重要意义.     

卫生保健提供系统的创新:公共卫生部门机构改革的理论框架

纵览全球，各国政府正在重新审视他们在卫生服务提供中的作用，这是卫生服务成本逐步攀升和消费者对卫生服务日益不满的结果。卫生部门面临的问题是公共服务提供系统面临的共性问题：缺乏技术效率和分配效率、劳动生产率低下、对消费者的需求缺乏反应，浪费严重，有时甚至有欺诈和腐败。人们承认：在许多情况下，卫生服务及其网络由供方占主导地位往往是问题的核心。越来越多的人认识到应该将其他公共部门的改革创新应用到卫生部门。而且，其他部门成功的改革已经导致许多国家探索将其应用于医院和其他卫生服务提供者的方法。但是，这方面的经验尚未有机地结合起来并提供给卫生部门的决策者和专家     

卫生保健提供系统创新：公共卫生部门机构改革的理论框架

纵览全球,各国政府正在重新审视他们在卫生服务提供中的作用,这是卫生服务成本逐步攀升和消费对卫生服务日益不满的结果。卫生部门面临的问题是公共服务提供系统面临的共性问题：缺乏技术效率和分配效率、劳动生产率低下、对消费的需求缺乏反应,浪费严重,有时甚至有欺诈和腐败。人们承认：在许多情况下,卫生服务及其网络由供方占主导地位往往是问题的核心。     

政府购买农村基本公共卫生服务绩效支付初探

本文介绍了公共卫生服务按绩效支付方式的定义、特点和应用情况,并以河南省武陟县购买高血压健康管理服务绩效支付方案为例,结合绩效支付特点和合同管理有关要求,分析了支付方案中存在的主要问题,并就加强公共卫生服务按绩效支付管理提出了操作建议。     

国外卫生系统绩效支付实践对我国的借鉴

绩效支付体系已经在多个国家得到了实施.通过探讨一些国家卫生系统实施绩效支付体系的情况以及实施过程中出现的问题,对我国建立卫生系统绩效支付体系提出了建议:(1)注重成本和长期效益;(2)重视服务对象的主观感受;(3)注意防止出现增加服务接受者成本的情况;(4)将试点首先放在公共卫生领域;(5)采取动态阶段式绩效支付体系.     

初级卫生保健统计知识

第七讲卫生服务利用指标分析卫生服务利用是描述卫生服务系统工作的客观指标。分析卫生服务利用的程度是检查卫生服务工作效率和潜力的一种常用手段。卫生服务利用指标能够直接反映卫生系统的工作,间接地通过卫生工作而对人群健康状况施加实际影响。在缺乏健康状况资料的情况下,分析卫生服务利用程度可以衡量卫生工作的效率。卫生服务利用量是受卫生资源状况及人群医疗需要量的制约,充分发挥卫生部门的主动性,可以使有限卫生资源充分发挥潜力,提高卫生服务的利用率。因此,分析卫生服务利用程度,常常是评价卫生事业的社会效     

Calcium intake in the elderly: validation of a dietary questionnaire

Epidemiological studies of calcium and osteoporosis have been hampered by the lack of a suitable tool for assessing calcium intake. This report describes a new frequency and amount questionnaire for measuring present and past calcium intake in the elderly. The validity of the questionnaire was tested against two commonly used standards of dietary assessment, five-day duplicate diets and seven-day weighed dietary inventories. The resulting correlation coefficients were, respectively, r = 0.76 and r = 0.69, while that for repeatability was r = 0.84. Furthermore, the questionnaire categorized subjects into thirds of the distribution of intake with almost no gross misclassification. It is suggested that the present findings may be extended to the majority of normal, healthy elderly subjects, implying wide application for the questionnaire in the assessment of calcium intake in the elderly.     

The occurrence of antimicrobial substances in toilet,sink and shower drainpipes of clinical units: A neglected source of antibiotic residues

Antibiotics represent one of the most important drug groups used in the management of bacterial infections in humans and animals. Due to the increasing problem of antibiotic resistance, assurance of the antibacterial effectiveness of these substances has moved into the focus of public health. The reduction in antibiotic residues in wastewater and the environment may play a decisive role in the development of increasing rates of antibiotic resistance. The present study examines the wastewater of 31 patient rooms of various German clinics for possible residues of antibiotics, as well as the wastewater of five private households as a reference.To the best of our knowledge, this study shows for the first time that in hospitals with high antibiotic consumption rates, residues of these drugs can be regularly detected in toilets, sink siphons and shower drains at concentrations ranging from 0.02?μg·L^?1 to a maximum of 79?mg·L^?1. After complete flushing of the wastewater siphons, antibiotics are no longer detectable, but after temporal stagnation, the concentration of the active substances in the water phases of respective siphons increases again, suggesting that antibiotics persist through the washing process in biofilms. This study demonstrates that clinical wastewater systems offer further possibilities for the optimization of antibiotic resistance surveillance.     

Self-reported health problems among Swedish miners one year after unemployment

Unemployment is considered to be a public health concern sincedeterioration in the health of the unemployed is often anticipated.However, for some groups, such as miners, unemployment mightimprove health due to a cessation of potentially harmful occupationalexposures. This study evaluates the health of 79 miners in oneSwedish iron-ore mine, and 226 age-matched controls from thegeneral population, during one year after the closure of themine. The participants received a questionnaire regarding medicalhistory and subjective symptoms at the beginning of the studyperiod, and after one year. Statistically significant negativeeffects on self-reported health attributable to unemploymentwere not found, although neuropsychiatric symptoms were morecommon among the unemployed miners. The miners reported a statisticallysignificant improvement in grip force (p=0.031). They had asignificantly higher prevalence of symptoms associated withmining related exposures when compared with the population controls;pain in the upper extremities [relative risk (RR)=2.27, 95%confidence interval (Cl)=1.44–3.59), back pain (RR=1.84;Cl=1.237–2.75), vasospastic disease of the fingers (RR=2.05;Cl=1.18–3.57) and obstructive respiratory symptoms (attacksof dyspnea and wheezing: RR=3.67; Cl=1.167–11.6).     

Excès de cas humains et animaux de tularémie en France au cours de l’hiver 2007–2008 : émergence ou phénomène isolé ?

Context

Tularemia is a zoonosis affecting humans and hares in France. We describe the results of surveillance in both species, in 2007 and 2008.

Methods

Human tularemia cases are mandatorily notifiable in France since 2003. In hares, surveillance relies on volunteer hunter associations in all districts of the country. Data from mandatory reports and volunteer surveillance in 2007/2008 were analyzed and compared with previous results.

Results

In 2007/2008, 144 cases were reported in humans and 117 cases in hares. This was a 100% increase compared to previous years. Human cases differed from those of previous years only by the frequency of contact with breeding animals. Human cases without any documented risk exposure were also more frequent.

Conclusion

An increase of tularemia cases occurred in 2007/2008 in both species. Complementary studies are needed to identify the species reservoir in France to understand the causes of this peak of cases.     

Occupational health hazards in mining: an overview

This review article outlines the physical, chemical, biological, ergonomic and psychosocial occupational health hazards of mining and associated metallurgical processes. Mining remains an important industrial sector in many parts of the world and although substantial progress has been made in the control of occupational health hazards, there remains room for further risk reduction. This applies particularly to traumatic injury hazards, ergonomic hazards and noise. Vigilance is also required to ensure exposures to coal dust and crystalline silica remain effectively controlled.     

Manufacture and use of nanomaterials: current status in the UK and global trends

This paper provides an overview of the production and use of nanomaterials (NMs), particularly in the UK. Currently, relatively few companies in the UK are identifiable as NM manufacturers, the main emphasis being the bulk markets in metals and metal oxides, and some niche markets such as carbon nanotubes and quantum dots. NM manufacturing in the UK does not reflect the global emphasis on fullerenes, nanotubes and fibres. Some assumptions have been made about the types of NM that are likely to be imported into the UK, which currently include fullerenes, modified fullerenes and other carbon-based NMs including nanotubes. Many university departments, spin-offs and private companies have developed processes for the manufacture of NMs but may only be producing small quantities for research and development (R&D) purposes. However, some have the potential to scale up to produce large quantities. The nanotechnology industry in the UK has strong R&D backup from universities and related institutions. This review has covered R&D trends at such institutions, and appropriate information has been added to a searchable database. While several companies are including NMs in their products, only a few (e.g. manufacturers of paints, coatings, cosmetics, catalysts, polymer composites) are using nanoparticles (NPs) in any significant quantities. However, this situation is likely to change rapidly. There is a need to collect more information about exposure to NPs in both manufacturing and user scenarios. As the market grows, and as manufacturers switch from the micro- to the nanoscale, the potential for exposure will increase. More research is required to quantify any risks to workers and consumers.     

深圳公立医院管理体制改革制度设计

深圳公立医院管理体制改革实行政事分开、管办分开,在理事会架构下按法定机构模式组建市医管中心,落实公立医院运营管理自主权.作者从当前公立医院管理体制的弊端入手,介绍了深圳市进行公立医院管理体制改革的基本思路及改革方案设计的主要举措,深入剖析了的改革方案的特点,并对改革效果进行了预测.     

Effects of nitrogen dioxide on red blood cells of rats: Changes in components of red cell membranes during in vivo exposure to NO2

Red cell membranes, prepared from red blood cells of rats exposed to 4, 10, or 20 ppm nitrogen dioxide (NO₂) for 1 to 10 days, were examined for evidence of changes in membrane components. Appreciable changes were not found in contents of phospholipid and cholesterol during exposure to 10 ppm NO₂. By contrast, protein content altered with the time of exposure. Moreover, changes in protein composition were observed by employing sodium dodecyl sulfate — polyacrylamide gel electrophoresis. Twenty-four-hour exposure to NO₂ at the concentration above 10 ppm resulted in a marked increase in the percentage of lysophosphatidylethanolamine (LysoPE) to the total phospholipids. The prolonged exposure to 10 ppm NO₂ gave rise to a further increase in LysoPE, whereas the percentage of phosphatidylethanolamine (PE) showed a gradual decrease. A 1-day exposure to 4.0 ppm NO₂ also caused an increase in sialic acid content and decreases in those of PE and hexose. In addition to contents of these components the percentage of LysoPE increased 5 days after exposure and the elevated values were maintained up to the end of exposure period. These results demonstrate that red blood cells in circulation exhibit different membrane properties in terms of lipid and carbohydrate composition during 10 days of exposure to 4.0 ppm NO₂.     

Investigating clusters in the workplace and beyond

Clusters of disease are common and occur in the workplace and in the general community. They often arouse considerable concern among the population. Investigations have sometimes lead to exciting new knowledge, but in general the investigation of clusters is difficult and often unrewarding, especially for community clusters. In the workplace, investigations are more likely to find associations and even new causes, but still many clusters remain enigmatic. Despite this, there are many reasons for investigating clusters, including allaying community concern and identifying uncontrolled exposures. A structure for investigating clusters in the workplace is suggested.