浅谈医院科室核算的管理办法

经济管理是医院管理的组成部分,要运用经济手段促使医院合理使用人力、物力和财力,提高医疗服务质量;要逐步实行科室核算,有效地控制支出,以提高医院的社会效益和经济收益。实行科室核算也是顺应医改和医院发展的必然趋势。我院在开展科室核算方面作了一点尝试和探索,现将开展情况介绍如下:     

谈医院科室核算存在的问题和对策

我省医院科室核算起步较早,在20世纪80年代末、90年代初。一些大中型医院就进行了以经济收入为主的科室核算。但随着社会主义市场经济的不断完善,医疗市场也发生了根本的变化,医院的发展面临着社会效益与经济收益、责任主体与利益主体、服务质量与耗费水平和医院收入与病人支出等种种矛盾。各医院为了适应新的社会发展需要,采取了不同的管理模式,医院的科室核算也出现了不同的类型,甚至有些医院误认为医院科室核算就是医院科室成本核算。为此,我们对青海省11家医院科室核算情况进行了调研。     

对市场经济条件下医院经营管理的思考

针对市场经济下医院面临的宏观政策的重大调整,经济体制改革特别是城镇职工医疗保险制度的全面实施等外环境的变化,以及居民健康需求的新变化,提出了医院经营管理必须要适应这些新变化,内部的经济管理内容要深化、范围要拓宽、结构要调整、制度要健全,并与行政管理、业务技术管理、政治思想管理等互动的思路;提出了医院开展成本核算,规范科室核算以及探索产权改革的建议等。     

试论我国医院成本核算的难点与对策

医院成本核算是医院对医疗服务过程中所发生的费用进行核算的过程。成本核算管理是医院在对费用进行核算的过程中 ,对费用成本进行控制 ,利用以成本核算为主的科室核算对医院进行经济管理的行为。在医院经济管理人员实施这一行为的过程中 ,既看到了成本核算 ,尤其是全成本核算给医院管理带来的累累硕果 ,也体验了核算过程中的种种难点和问题。现在 ,笔者就医院进行科室核算过程中碰到的与成本核算相关的几个问题在此与各位同行讨论一下 ,借此与大家一起研究我国医院成本核算的难点和对策。1　我国医院成本核算的现状社会主义市场经济体制和…     

医院经济管理与科室核算的几点思考

医院经济管理和实行科室核算解决了在计划经济体制下的“看病难、住院难、手术难”的问题,但也存在一些弊端,需要规范与完善;（1）收入的划分及其比例;（2）成本项目的内容及费用定额;（3）各个责任科室可实行支配的收入比例;（4）强化体现质量的指标等,使医院经济管理适应社会主义市场经济体制,适应城镇医药卫生体制改革。     

科室核算电算化在我院的应用和成效

为了更好地开展医院的经济管理和科室核算工作．我院与石家庄市景天软件公司共同开发了一套科室核算软件．经过4年科室核算电算化的不断实践和完善．各项考核指标的规范实施，极大地调动了职工的积极性，1999—2004年．我院年平均门诊量增长了18．4％．住院病人年平均增长了29.3％，病人满意率达94．5％．这期间我院多次被评为山东省德州市卫生系统的先进单位。科室核算电算化大大地提高了医院的工作效率和管理水平．使我院的经济管理．特别是科室核算电算化工作走在同行业的前列．     

医院两级核算利弊及其对策

一、现状调查医院两级核算是以经济学、会计学的一般方法,对医院业务科室或项目实施经济核算、控制与协调的有效管理手段。为了掌握医院两级核算的基本情况,我们对上海市卫生部门８８所区(县)级以上医院(含教学医院)进行了调查。１．按照核算内容,医院两级核算模式大致可以归纳为六种:核算科室的全部收入和全部支出(含药品收入和药品支出);核算科室的全部收入和全部支出(剔除药品收入药品支出);核算科室的收入(药品收入);核算科室的支出(药品支出);仅核算药品收入以外的业务收入;仅核算药品支出以外的业务支出。大多数医院在核算收入的同时…     

谈医院两级核算管理

医院两级核算是为了保证微观经济良性运行、适应市场经济的客观要求、提高工作效率为重点的激励机制 ,合理利用医疗资源的制约机制 ,现就有关问题进行阐述。一、两级核算对医院管理的作用(一 )医院两级核算对业务管理的作用 :1.医院经济核算增强了各科室谋生存、求发展的意识 ,科室根据自身管理要求 ,行使自主权 ,发挥各自优势 ,主动适应医疗服务市场 ,创造性地开展工作 ,不断开拓医疗服务领域 ,改变工作作风和服务态度 ,从而取得了很多的社会效益和经济效益。2 .医院在实行两级核算后 ,材料支出、能源支出明显下降 ,科室都建立领料台帐 ,定…     

强化医院成本管理走内涵发展之路

成本核算是医院经济管理的基础工作,加强成本管理是医院经营管理的重要环节。在宏观经济政策发生重大变化的条件下,我院通过不断强化医院成本管理,努力减少消耗、降低成本、提高效益,走出了一条内涵效益型发展之路。1做法1.1建立核算网络为了加强成本管理,提高经济效益,医院设立了由院长主持的成本核算小组,包括医教部、政治部、院务部、护理部、药剂科、设备科、信息资料科等职能部门、科室组成的核算网络,负责实施管理会计工作。各科室设立1名兼职核算员,协助主任对本科室的收入和支出及医护人员的工作量进行核算,使成本核算工作规范化、…     

医院成本核算有关问题探讨

一、成本核算的性质 医院各科室的成本核算实行单独核算、自收全支、自负盈亏。科室成本核算属于二级核算,对医院实行报帐制。为了加强对各科室的经济管理,医院视情况可建立经济管理委员会或经济管理科,负责各科室的经济管理工作。同时,各科室应成立经济管理小组,一般由科主任或护士长兼任组长,并设1名核算员负责科内的核算工作。     

Three methods for analysing correlated ROC curves: a comparison in real data sets from multi-reader,multi-case studies with a factorial design

This paper compares three published methods for analysing multiple correlated ROC curves: a method using generalized estimating equations with marginal non-proportional ordinal regression models; a method using jackknifed pseudovalues of summary statistics; a method using a corrected F-test from analysis of variance of summary statistics. Use of these methods is illustrated through six real data examples from studies with the common factorial design, that is, multiple readers interpreting images obtained with each test modality on each study subject. The issue of the difference between typical summary statistics and summary statistics from typical ROC curves is explored. The examples also address similarities and differences among the analytical methods. In particular, while point estimates of differences between test modalities are similar, the standard errors of these differences do not agree for all three methods. A simulation study supports the standard errors provided by the generalized estimating equations with marginal non-proportional ordinal regression models.     

Lipids and lipoproteins in new immigrant Ethiopian Jews in Israel

In an investigation of lipid levels following a period of deprivation and prolonged travel, 206 male and 272 female Ethiopian Jewish immigrants to Israel were evaluated at the end of 1984. This ethnic group, most of whom are lean persons who had apparently consumed a high simple carbohydrate diet, revealed distinct (cross-sectionally evaluated) age and sex patterns of lipid distribution. Total cholesterol in the Ethiopians resembled that in Israeli-born adolescents or adult resident Israelis at ages 8 years through 20-29 years, but mean levels were considerably lower in Ethiopians at ages 30-39 years through 60 years, where they do not exceed 175 mg/dl for males and 190 mg/dl for females. Mean triglyceride levels were higher for Ethiopian females than in Israeli females up to age range 40-49 years. While the levels in Israelis increase steadily with age, no clear age pattern was discernible in the levels in the Ethiopians (at least cross-sectionally). Among the Ethiopian males, levels were considerably higher than those among Israeli males in childhood and adolescence. In Ethiopian adults, the triglyceride levels appeared to be slightly lower than those in resident Israelis. The Ethiopian immigrants displayed markedly reduced high density cholesterol (38 mg/dl for males, 39 mg/dl for females) compared with levels of between 50 and 53 mg/dl for Israelis at age 8-9 years. These differences diminished with age, until, at around age 20-29 years, mean levels became comparable (around 42 mg/dl for males and 50 mg/dl for females) and remained so at older ages. The distinct lipid patterns in the Ethiopian Jewish immigrants to Israel are subject to ongoing follow-up to investigate the effect of a quasi-western diet and a western lifestyle on this ethnic group.     

Reassessing policy paradigms: A comparison of the global tobacco and alcohol industries

Tobacco is widely considered to be a uniquely harmful product for human health. Since the mid-1990s, the strategies of transnational tobacco corporations to undermine effective tobacco control policy has been extensively documented through internal industry documents. Consequently, the sale, use and marketing of tobacco products are subject to extensive regulation and formal measures to exclude the industry from policy-making have been adopted in the Framework Convention on Tobacco Control. In contrast to tobacco, alcohol is subject to less stringent forms of regulation, and the alcohol industry continues to play a central role in policy-making in many countries and at the global level. This article examines whether there is a sufficient rationale for such different regulatory approaches, through a comparative analysis of the political economy of the tobacco and alcohol industries including the structure of the industries, and the market and political strategies they pursue. Despite some important differences, the extensive similarities which exist between the tobacco and alcohol industries in terms of market structure and strategy, and political strategy, call into question the rationale for both the relatively weak regulatory approach taken towards alcohol, and the continued participation of alcohol corporations in policy-making processes.     

呼吸机管路清洗消毒机的性能分析与应用

目的通过分析比较,探讨不同品牌清洗消毒机所存在的共性和个性差异,实现有针对性的选择和使用清洗消毒机,使清洗消毒工作更加规范。方法对市场上现有不同国别品牌的呼吸机外管路清洗消毒机的性能、综合指标和技术参数进行筛选统计、列表分析比较。结果洁定GETINGE46-4、史蒂瑞STERIS444、樱花SAKU-RA WUS-3100在清洗消毒原理、预设程序及自动清洗过程等共性参数比较中基本相同,在干燥系统和喷射系统等6项个性指标比较中存在差异,可以根据临床不同需求进行有针对性的选择。结论因地制宜的选择适合的机型是确保呼吸机外管路及附件清洗消毒到位的关键因素之一。     

PCB Congener Profiles in Nestling Tree Swallows and Their Insect Prey

Tree swallows (Tachycineta bicolor) are widely used as indicators of local polychlorinated biphenyl (PCB) contamination in North America. Although determining total PCB residues in tissues is useful in environmental monitoring, analysis of PCB congener profiles may reveal sources of contamination and thus prove to be a more refined tool to track contaminants through the food web. To show how differences in PCB congener patterns in birds can be linked to the PCB patterns in their prey, we evaluated PCB congeners in tissues of tree swallow nestlings and their insect prey using principal component analysis and Euclidean similarities. The PC1 scores for PCB residues in nestlings fell between those of the Hexagenia (Ephemeroptera, mayflies) and Chironomidae (Diptera, midges), the two major prey groups of the nestlings. The congener pattern was not related to the location of nest boxes within the study area. However, Hexagenia insects and the nestlings that consumed them were richer in less chlorinated congeners and had higher PC1 scores than Chironomidae insect. In concordance, congener pattern of nestlings that hatched earlier and consumed more mayflies was more similar than that of other nestling to the pattern of nestings texagenia as calculated by Euclidean similarities. We point to the importance of understanding the seasonal availability of specific types of insect prey and their PCB congener pattern before these data are applied in models of trophic transfer of individual PCB congeners within a food web.     

NON-PARAMETRIC METHODS FOR COMPARING MULTIPLE TREATMENT GROUPS TO A CONTROL GROUP,BASED ON INCOMPLETE NON-DECREASING REPEATED MEASUREMENTS

In the comparison of two or more treatment groups to a control group, consider a study with non-decreasing repeated measurements of the same characteristic taken over a common set of time points for each subject. Based on the vector of possibly incomplete responses from each subject, this paper considers asymptotically distribution-free tests of the equality of the groups. I propose consistent point estimators of the overall treatment differences and I derive non-parametric simultaneous confidence regions for the treatment effects. An example using data from a bladder cancer study illustrates the proposed methods.     

Iron stores in users of oral contraceptive agents

A comparison of serum ferritin and other parameters of iron status was made between 46 women taking oral contraceptive agents (OCAs) for two or more years continuously and 71 women who never took OCAs. The mean serum ferritin level for the OCA users was 39.5 +/- 21.5 ng/ml and the control group mean level was 25.4 +/- 15.96 ng/ml, which is significantly different at p less than 0.001. Serum transferrin, serum iron, TIBC, MCH and MCHC levels were significantly greater for the OCA users group. Significantly lower RBC and hematocrit levels were found for OCA users while other parameters, hemoglobin, MCV and percent transferrin saturation, were not significantly different. No major differences in subject characteristics and dietary traits were evidenced, except a difference in reported menstrual cycle losses and a higher heme iron content in the diet of the OCA users.     

Storage of some organochlorine compounds in toxemia of pregnancy

Nine out of 18 cases of toxemia of pregnancy had high PCB serum levels in comparison with a control group of 12 women with normal pregnancies. Seven out of the nine high PCB levels cases were multiparae. These findings suggest a role of PCBs in the promotion of toxemia of pregnancy, possibly by depressing the maternal immunological response to fetal antigens. The pattern of the gas chromatogram of PCBs differed in the control and in the low PCB levels toxemia groups, due possibly to differences in some hormonal and/or enzymatic activities. In the high PCB levels toxemia cases, the chromatograms showed high peaks at 8. This fact adds to the quantitative dimension a qualitative one. The $\text{DDT}\text{DDE}$ ratios were lowest in the high PCB levels toxemia group suggesting an increased degradation of DDT to DDE and/or a decreased excretion of DDE.     

An empirical analysis of the demand for physician services across the European Union

This paper presents parameter estimates for physician service equations using the "European Community Household Panel" for 12 countries covering the period 1994-1996. The focus is on two specific points: (1) the identification of behavioural similarities and differences in the demand for health services across the 12 countries; (2) the variability in demand for health services represented through a joint model for all countries. We found that there are significant differences among countries, although there are also similarities in the effect of variables such as health stock, labour situation or family structure. An important fraction of the variability in the demand for health services across countries could be explained by differences in age, income and the role of general practitioners as gatekeepers in the public health system. We found some evidence of induced demand in the decision to visit a specialist and in the number of such visits.     

In search of a common currency: A comparison of seven EQ‐5D‐5L value sets

The recently published EQ‐5D‐5L value sets from Canada, England, Japan, Korea, the Netherlands, Spain, and Uruguay are compared with an aim to identify any similarities in preference pattern. We identify some striking similarities for Canada, England, the Netherlands, and Spain in terms of (a) the relative importance of the 5 dimensions; (b) the relative utility decrements across the 5 levels; and (c) the scale length. On the basis of the observed similarities across these 4 Western countries, we develop an amalgam model, WePP (western preference pattern), and compare it with these 4 value sets. The values generated by this model show a high degree of concordance with those of England, Canada, and Spain. Patient level data were obtained from the Multi‐Instrument Comparison project, which includes participants from 6 countries in 7 disease groups (N = 7,933): The WePP values lie within the confidence intervals for the value sets in Canada, England, and Spain across the whole severity distribution. We suggest that the WePP model represents a useful “common currency” for (Western) countries that have not yet developed their own value sets. Further research is needed to disentangle the differences between value sets due to preference heterogeneity from those stemming from methodological differences.