Estimation of financial burden due to oversupply of medications for chronic diseases

Given the potential of financial burden due to oversupply of medications for chronic diseases, this study aims to determine the prevalence of oversupply and to estimate the magnitude of financial loss in Thailand. Electronic patient database in a university-affiliated hospital in Thailand was used. Based on the utilization of top 5 high drug expenditure in 2005, the prevalence and the financial loss of oversupply (medication possession ratio [MPR] >1.00) were estimated. In total, 1893 patients were included in this study. The average age was 65.2 years and the majority were female (56%). The prevalence of oversupply ranged from 23.2% to 62.8%, whereas the annual financial loss ranged from US $4108 to US $10 517. The total amount of loss was US $32 903 or 3.77% of total medication costs. In summary, because of the high prevalence and associated high financial loss, oversupply of medication is a significant financial burden on hospitals and society.     

武汉市医院信息化建设现况调查

目的了解武汉市医院信息化建设状况,为科学合理制订武汉市医院信息化建设规划提供依据。方法按医院类型分层随机抽取52家医院,通过问卷调查和访谈收集医院信息化建设基本数据。结果武汉卫生信息化发展很快,各医院都加大资金建设和改善卫生信息系统,大约91%的医院建立了医院信息化系统,信息化建设资金投入占年均销售额比例平均为0.54%,71.43%的医院设置了专门的信息化部门。但是,医院信息化子系统的应用情况参差不齐,部分医院负责人尚未认识到医院信息化的重要性。结论国家应加强信息化工作的管理和指导,专业机构应制定相应的信息化标准规范和建设规划,医院领导应重视医院信息化建设,加大信息化建设的资金投入,加强人才队伍建设。     

A two-tiered public-private health system: Who stays in (private) hospitals in Ireland?

Despite efforts to create a universal, single-tiered Irish health system, an unequal "two-tiered" system persists. The future blueprint for Irish health care, Sláintecare, recommends a separation of public and private hospital treatment. This study examines patterns of overall and private hospital utilisation in Ireland that could help identify some of the impacts of the proposed separation of public and private hospital treatment. Using data from EU-SILC (2016) (n = 10,131) the factors associated with inpatient hospitalisation and private inpatient hospitalisation are estimated using probit models.Unsurprisingly, those who are economically inactive are more likely to have had an inpatient stay. Furthermore, those aged over 65, with a chronic illness, with a medical/ GP visit card and private health insurance and those with only private health insurance are also more likely to have had an inpatient stay. Those with only primary education are less likely to report an inpatient stay in private hospital. Those aged over 25 and less than 65, those with a medical/ GP visit card and private health insurance and those with only private health insurance are significantly more likely to opt for a private hospital. Understanding overall and private hospital utilisation patterns is imperative for implementing universal health care and associated resource planning and fulfilling policy recommendations.     

Estimación del coste hospitalario del cáncer colorrectal en Cataluña

ObjectiveTo assess the hospital cost associated with colorectal cancer (CRC) treatment by stage at diagnosis, type of cost and disease phase in a public hospital.MethodsA retrospective analysis was conducted of the hospital costs associated with a cohort of 699 patients diagnosed with CRC and treated for this disease between 2000 and 2006 in a teaching hospital and who had a 5-year follow-up from the time of diagnosis. Data were collected from clinical-administrative databases. Mean costs per patient were analysed by stage at diagnosis, cost type and disease phase.ResultsThe mean cost per patient ranged from 6,573 Euros for patients with a diagnosis of CRC in situ to 36,894 € in those diagnosed in stage III. The main cost components were surgery-inpatient care (59.2%) and chemotherapy (19.4%). Advanced disease stages were associated with a decrease in the relative weight of surgical and inpatient care costs and an increase in chemotherapy costs.ConclusionsThis study provides the costs of CRC treatment based on clinical practice, with chemotherapy and surgery accounting for the major cost components. This cost analysis is a baseline study that will provide a useful source of information for future studies on cost-effectiveness and on the budget impact of different therapeutic innovations in Spain.     

卫生经济改革对医院管理行为的影响研究

该文主要验证两项假设:卫生经济政策对医院管理行为有影响和政策决策者与医院管理者的目标有差异.资料来源于政策文件和对淄博和南通市的现场调查,分析采用以定性为主的时间序列方法.主要结论是医院管理行为对应卫生经济改革总体上时间滞后,医院经济管理将进入成熟期,卫生经济政策不能落实的原因之一是政策制定者和医院管理者的目标不一致.     

Analytic hierarchy process for hospital site selection

Aim: This study investigated a decision support model for site selection to establish a new hospital based on the analytic hierarchy process (AHP). The main purpose of this study was to select the best site for a hospital using this process in Mu?la, Turkey.Method: AHP was employed as the methodological tool for the selection of the site. The study was based on 6 criteria and 19 sub-criteria. All districts in the province of Mu?la were evaluated as alternatives. These districts include: Bodrum, Dalaman, Datça, Fethiye, Kavakl?dere, Koyce?iz, Marmaris, Mente?e, Milas, Seydikemer, Ula, and Yata?an. The alternatives were ranked using a 1–9 Saaty scale. The analysis of the hierarchy model was conducted by using the Super Decisions 2.2.6 software program.Results: Results show that demand is the most important factor in determining the appropriate hospital site, followed by accessibility, competitors, government, related industry and environmental conditions. According to the results, Bodrum was chosen to be the best site to establish a new hospital.Conclusion: Due to limited resources in developing countries such as Turkey, it is critical that decisions are made as a result of scientific research. In this context, investors need to take into account some factors in line with this aim. The proposed evaluation criteria provide a reference for hospital administrators and investors in the selection of hospital sites using AHP.     

Lessons from understanding the role of community hospital director in Thailand: clinician versus manager

In 2001, Thailand adopted the Universal Health Coverage (UHC) policy. This policy focuses on primary health care (PHC), with the aim of reforming the Thai health system to provide health services to all, regardless of a person's ability to pay. The community hospital director (CHD) is the middle manager of the provincial health system and the leader of the district health system of Thailand. In recent reforms the emphasis for improving efficiency lies with changes in the provision of primary health services at the community level and this entails understanding the role of the CHD. A qualitative study, utilizing individual interviews and a focus group discussion, was undertaken in order to understand the factors affecting the implementation of rural health care in Thailand. Findings identified several barriers that limit the role of the CHD and a major result of the study was recognition of the dual role of the CHD as both clinician and manager. This study concluded that the goal of the UHC policy in providing equity of access to PHC to all citizens may not be achieved unless the role of CHDs is supported with training in health management and PHC and is supported by the government.     

Erlang could have told you so—A case study of health policy without maths

Little consideration is given to the operational reality of implementing national policy at local scale. Using a case study from Norway, we examine how simple mathematical models may offer powerful insights to policy makers when planning policies. Our case study refers to a national initiative requiring Norwegian municipalities to establish acute community beds (municipal acute units or MAUs) to avoid hospital admissions. We use Erlang loss queueing models to estimate the total number of MAU beds required nationally to achieve the original policy aim. We demonstrate the effect of unit size and patient demand on anticipated utilisation. The results of our model imply that both the average demand for beds and the current number of MAU beds would have to be increased by 34% to achieve the original policy goal of transferring 240 000 patient days to MAUs. Increasing average demand or bed capacity alone would be insufficient to reach the policy goal. Day-to-day variation and uncertainty in the numbers of patients arriving or leaving the system can profoundly affect health service delivery at the local level. Health policy makers need to account for these effects when estimating capacity implications of policy. We demonstrate how a simple, easily reproducible, mathematical model could assist policy makers in understanding the impact of national policy implemented at the local level.     

Room size is the major determinant for tuberculin conversion in health care workers exposed to a multidrug-resistant tuberculosis patient

Objective Transmission of Mycobacterium tuberculosis (MTB) to health care workers (HCWs) still represents a public health concern. A total of 71 obstetric workers underwent contact tracing after recent workplace exposure to a highly infectious multidrug-resistant tuberculosis patient [i.e., index case (IC)]. Aim of the study was to identify the main exposure predictors for the risk of conversion through evaluation of tuberculin screening results. Methods HCWs were investigated by a questionnaire (community, occupational, IC exposure risk factors) and tuberculin skin test screening. Results Conversion was detected in 5 (8%) of the 63 exposed workers and was not associated with either community or previous work-related risk factors. According to risk assessment, tuberculin conversion was related to neither amount time of exposure, workshifts, nor number of contacts. Conversely, an exposure to the IC in different hospital rooms was found significantly different among converters compared to non-converters (χ ², P = 0.004). In particular, conversion was associated with exposure in two (obstetric emergency room, ambulatory discharge) out of the nine contact environments. Tuberculin conversion rates were associated with the room cubations of the exposure environments (χ ² for trend, P < 0.01) and with worker age. In a logistic regression model adjusted for age, the lower room cubation was found the strongest predictor for tuberculin conversion (OR = 2.46, P = 0.02). Conclusion The study shows that the factors affecting airborne mycobacterial dose (patient infectiousness, low sized confined rooms) were the major determinants for MTB transmission after a brief exposure to a highly infectious TB case. Author’s statement: The Occupational Health Unit (OHU) is in charge of the mandatory health surveillance program for the Policlinico hospital workers according to the national laws. The results of this investigation have not been and will not be published elsewhere. Neither financial support nor conflict of interest for any authors is present in this study.     

我院科室核算系统的特点和深化方向

我院实施“上海市总量控制结构调整”新政策后,开发科核算信息管理系统,实行以经济核算为主的资金分配制度,比较结果表明成铲显著,医疗总费,药品费,检查费,材料费均得到有效控制;医院服务总量增加,而平均床日数显著缩短。随着医院改革的深入,需要实行病区计算机管理及建立医院信息网络系统,可以进一步提高医院综合经济效益。     

Identification of Unmet Healthcare Needs: A National Survey in Thailand

Objectives:This study examined demographic factors hampering access to healthcare at hospitals and suggests policy approaches to improve healthcare management in Thailand.Methods:The data for the study were drawn from a health and welfare survey conducted by the National Statistical Office of Thailand in 2017. The population-based health and welfare survey was systematically carried out by skilled interviewers, who polled 21 519 384 individuals. The independent variables related to demographic data (age, sex, religion, marital status, education, occupation, and area of residence), chronic diseases, and health insurance coverage. The dependent variable was the degree of access to healthcare. Multiple logistic regression analysis was subsequently performed on the variables found to be significant in the univariate analysis. Results:Only 2.5% of the population did not visit a hospital when necessary for outpatient-department treatment, hospitalization, or the provision of oral care. The primary reasons people gave for not availing themselves of the services offered by government hospitals when they were ill were—in descending order of frequency—insufficient time to seek care, long hospital queues, travel inconvenience, a lack of hospital beds, unavailability of a dentist, not having someone to accompany them, and being unable to pay for the transportation costs. Multiple logistic regression analysis showed that failure to access the health services provided at hospitals was associated with demographic, educational, occupational, health welfare, and geographic factors. Conclusions:Accessibility depends not only on health and welfare benefit coverage, but also on socioeconomic factors and the degree of convenience associated with visiting a hospital.     

新疆某二级医院住院医保定额管理模式探讨

目的：研究定点医院如何科学、合理地用足用好各社保局分配的住院医保定额。方法通过自身前后对比法和德尔菲法,对新疆某二级甲等综合性医院2011—2014年给各临床科室二次分配和实际使用的住院医疗保险基金的额度进行对比,对医院住院医保定额管理与控制进行相关分析和评价。结果定点医院通过对住院医保定额的二次分配,13%的临床科室超出核定的额度,87%的临床科室完成的额度控制在合理的区间。结论在定点医院推广住院医保定额管理模式有效控制了住院医疗保险定额的超支比例,提高了医保基金的总额预算和总控成效,避免了定点医院因住院医保定额超支导致医疗保险基金分担的经济风险。     

Does free choice of hospital conflict with equity of access to highly specialized hospitals? A case study from the Danish health care system

Equity of access to health care is a central objective of European health care systems. In this study, we examined whether free choice of hospital, which has been introduced in many systems to strengthen user rights and improve hospital competition, conflicts with equity of access to highly specialized hospitals. We chose to carry out a study on 134,049 women who had uncomplicated pregnancies from 2005 to 2014 in Denmark because of their homogeneity in terms of need, the availability of behavioral data, and their expected engagement in choice of hospital. Multivariate logistic regression was used to link the dependent variable of bypassing the nearest non-highly specialized public hospital in order to “up-specialize”, with independent variables related to socioeconomic status, risk attitude, and choice premises, using administrative registries. Overall, 16,426 (12%) women were observed to bypass the nearest hospital to up-specialize. Notably, high education level was significantly associated with up-specialization, with an odds ratio of 1.50 (95% CI: 1.40–1.60, p < 0.001) compared to low education group. This confirms our hypothesis that there is a socioeconomic gradient in terms of exercising the right to a free choice of hospital, and so the results indicate that the policy exacerbates inequity of access to health care.     

我国医院循证管理与卫生技术评估研究可视化分析

目的 分析我国医院循证管理与卫生技术评估的研究热点和趋势，为未来研究指明方向。方法 在中国知网、万方和维普数据库检索相关文献，共纳入548条文献记录，采用NoteExpress 3.3软件进行计量分析，采用VOSViewer 1.6.18软件进行关键词聚类分析，采用CiteSpace 5.8.R3软件进行突变词分析。结果 第一篇文献出现于2001年，2015年开始文献数量激增并总体呈增长趋势；逐步形成了循证实践、卫生技术评估、循证管理、循证医学、医院管理、循证评价、护理管理7类核心主题；研究热点为循证实践、护士、医用耗材、循证管理。结论 公立医院外部治理政策的变化加速了医院循证管理与卫生技术评估研究的进程；循证科学范式促进了循证理念与医院管理的融合；护理领域的循证实践为最新研究热点；医院卫生技术评估逐步成为了医院循证管理的重要工具。     

总额限定下医院绩效考核体系的构建与探讨

由于松江区已实行收支两条线管理以及绩效工资政策,医院原先三维度考核办法已不再适合新形势的要求.通过借鉴其它医院经验及结合医院实际,构建了一个既不突破核定总额又能体现医务人员劳动价值,涵盖量、质的绩效考核体系,希望为松江卫生综合改革及其它实施收支两条线管理的地区提供借鉴.     

城市医院发展面临的主要矛盾及其改革走向

分析了城市医院目前面临的主要问题与矛盾,即投入补偿不足严重制约医院的生存和发展;卫生服务价格政策不合理迫使医院侧支循环;宏观规划及调控政策不配套严重影响正常的医疗秩序;医学高级人才严重不足制约医疗技术水平的提高和医院发展。在此基础上提出了城市医院深化改革的走向及发展对策:完善卫生经济政策,增加城市医院投入;调整卫生收费标准,理顺卫生服务价格;加快高级人才培养,提高队伍整体素质;深化卫生管理改革,全面提高诊疗水平;加强宏观规划调控,健全医疗服务体系。     

Reports of evidence planting by police among a community-based sample of injection drug users in Bangkok, Thailand

Background  

Drug policy in Thailand has relied heavily on law enforcement-based approaches. Qualitative reports indicate that police in Thailand have resorted to planting drugs on suspected drug users to extort money or provide grounds for arrest. The present study sought to describe the prevalence and factors associated with this form of evidence planting by police among injection drug users (IDU) in Bangkok.     

1985年-2017年医院评审评价相关中文文献计量分析*

目的通过对1985年-2017年医院评审评价相关研究的中文文献进行计量学分析,为拟定未来研究重点提供技术依据。方法系统检索万方、CNKI、维普数据库,运用描述性统计方法整理文献发表时间、作者单位、期刊、 关键词等信息。结果检索出13 432篇文献,清洗后余1 665篇,1985年-2011年之间,文献发表较少,累积量不超过50%,2011年之后文献迅速增长,与我国医院床位数增长速度基本呈正相关。作者以北京最多,占16.06%;东中 西部文献发表量差别巨大,东部平均为56篇,中部为27.13篇,西部为21.78篇;各省文献积累量与2016年医院床位数不成正比。依据布拉德福定律对杂志进行分区,核心区杂志8种期刊均为医院管理类杂志,发表的文献占文献 总量的33.39%。2 414个关键词中共有高频关键词13个。主要涉及医疗质量、综合评价、持续改进、护理质量、评审标准等内容。聚类显示文献中对于医院质量和管理关注较多。结论我国医院评审评价的相关研究数量在快速增 长,但是不同地区文献累积量差异巨大,且缺少与具体临床问题相结合的研究,缺少对国家和地区层面的研究与探讨。