卫生计生财政预算项目绩效评价指标体系研究

目的:建立卫生计生财政预算项目绩效评价指标体系,有效开展预算项目绩效评价工作。方法:采用德尔菲法进行备选指标筛选,用集值法确定指标权重。结果:经过三轮指标筛选,构建了包括25项共性指标和38项个性指标、涉及基本建设、设备购置、重点学科建设、公共卫生服务四大类的卫生计生预算项目绩效评价指标体系。结论:卫生计生预算项目绩效评价指标体系具有较高的科学性、合理性、系统性和可操作性,今后将通过大量实证加以验证和完善。     

研制我国疾病预防控制绩效考核指标体系

围绕层次化和条理化的考核框架,课题组经过＂指标收集—指标筛选—指标界定＂3个步骤,确立了我国疾病预防控制绩效考核指标体系：区域绩效考核6个类别17个指标,省级机构8个类别34个项目77个指标,市级机构8个类别35个项目110个指标、县级机构8个类别35个项目101个指标。一系列的研制思路、过程和方法确保了指标体系的科学性、合理性和可操作性,为后续确定指标权重、建立综合评价模型奠定了基础。     

浅谈现行医院财务制度下固定资产的会计核算

本文分析了在现行《医院财务制度》下,医院固定资产在购置、计提修购基金、处置、减值时会计核算方面存在的缺陷,并借鉴企业会计制度的核算方法,建议提出了取消＂固定基金＂和＂专用基金——修购基金＂科目,增设＂累计折旧＂、＂固定资产清理＂和＂固定资产减值准备＂科目,以如实反映医院固定资产的规模、新旧程度和实际价值,便于会计报表使用人作相关决策。     

贵重仪器设备论证审批研究新进展及自动化系统

文章进一步探讨了高校仪器设备购置项目的论证、审批及采购实施各环节要素及注意事项,针对购置项目论证存在的问题,提出系统化的解决方案。根据实践经验对所设计建立的动态网络化论证审批管理系统进行了完善,较好地提高了论证工作的质量与效率,实现了从项目申报、论证、审批、招标等的流程化管理,执行状态一目了然,方便及时提供各状态详尽的统计数据。     

刍议医疗设备招标采购

针对预防医疗卫生系统采购领域商业贿赂的种种举措,根据我院购置医疗设备的实际,探讨医疗设备招标采购程序、制度和经验,提出医疗设备招标的＂质量保证,价格优先＂的原则。     

“军卫一号”固定资产管理子系统的实践与思考

提出应在＂军卫一号＂固定资产管理子系统的平台上增加3个功能模块,解决了医院在医疗设备购置计划管理、医学计量设备管理和医疗设备效益分析实际工作中遇到的数据量大、工作效率低等问题,为更好地实现医院医疗设备的规范化和科学化管理提供参考。     

贵重医疗仪器购置的论证误区与建立三级论证制的必要性

近年来，国家卫生部和军队卫生部对全国各有关医疗单位购置贵重医疗仪器的行为实行了不同程度的控制，其中针对医疗仪器购置工作中所表现出的盲目性等问题，建立了项目申报和配置认可制度，并特别规定了在申报项目之前必须经各单位的医疗仪器论证委员会实施论证。医疗仪器购置前的论证，是医疗仪器购置全过程当中必不可少的步骤。但是，纵观整个医疗仪器购置过程及内外环境的影响，在具体实施论证的过程中，如不对各个环节进行实事求是的分析和有效的组织，极易不自觉地走进违背论证的固有规律以致达不到最终论证目的误区。其一，有的仪器论…     

减少设备运营成本的技术

如果你能把成像设备和过时的计算机变成金子，则至少在物资管理的领域内象额外成本、超额预算这些难听的字眼将不会存在。实验室、放射科、肿瘤科以及其他学科科室因需要昂贵的设备护理病人和挽救生命造成固定设备成本增加。你知道所需的项目，因为它们已在预算中，并且你也花了大量的时间来讨论最好的购置项目。多数情况下物资管理人员精通于减少高额设备购置成本的技术，从而为医院减少了购置成本。但是，在购买过程中减少设备运营成本的技术经常被人们的忽视或不了解，导致维护和运营成本在整个设备生命周期内积聚，超过了购置成本。如果…     

医院图书馆资源建设的问题与对策

对当前医院图书馆资源建设中存在的经费有限、纸本文献资源购置随意和盲目、电子资源购置缺乏科学系统的评估和理性分析等种种弊端,在调研和实践的基础上,从文献筛选的原则和方法、加强馆内文献资源的整合和建设,加强馆内及其他馆间文献资源的共建共享与协作3方面,进行可行性的对策研究。     

夹江县对医疗卫生单位基建项目和医疗设备实行有偿投资

夹江县卫生局从1988年6月起,改革县、区、乡医疗卫生单位基建项目和购置医疗设备的管理办法,实行基建项目和医疗设备有偿投资。这一管理办法是:各医疗卫生单位新建项目和购置医疗设备,应提前拟定计划,落实自筹资金,向卫生局提出书面申请,双方签订合同后方可修建或购置。凡卫生局投入的资金,县、区医疗卫生单位偿还80％,分三年(第一年20％,第二、第三年分别为30％)偿还。乡卫生院偿还60％,分四年(每年15％)偿还。卫生局又将这些资金用于再建或续购经费。实     

Economic aspects of cervical cancer screening

The results of a cost-effectiveness analysis of cervical cancer screening in The Netherlands are reported, emphasizing the analysis of the costs of screening and consequent diagnosis and treatment. Many organized screening policies are evaluated, differing in age-range and interval between screens. The cost estimates are based on organization charts, file studies and tariffs. The costs of screening itself are by far the most important cost component. Screening increases the costs of diagnosis. Costs for primary treatment only rise for large screening policies. Screening causes savings in costs of terminal treatment, but these are small compared with the costs of screening. The costs per life-year gained for the most efficient policies amount to DFL 24,000 for the policy with 7 invitations per woman in a lifetime and rise considerably in case of more than 10 invitations. Cervical cancer screening appears to be less cost-effective than breast cancer screening, but compared with other services the results are comparatively good. Implementing one of the efficient organized screening policies and discouraging spontaneous screening beyond that schedule leads to considerable savings. Moreover, many organized policies which are not efficient are still superior to spontaneous screening.     

Screening for diabetic retinopathy: a relative cost-effectiveness analysis of alternative modalities and strategies.

Diabetic retinopathy is the most common cause of blindness among adults of working age in the UK. If the disease is detected early effective treatment can be provided and this has resulted in calls for a systematic national screening programme. Using data on the screening of 3423 diabetics collected as part of an experimental programme in three UK centres, the relative cost-effectiveness of various screening options is assessed. The paper utilises direct evidence on a number of single modality screening options, including ophthalmoscopy undertaken by general practitioners or ophthalmic opticians, and non-mydriatic photography. With the objective of increasing the sensitivity of screening and using data collected in the study, options based on two further potential screening strategies are modelled and evaluated: combined screening using both ophthalmoscopy and non-mydriatic photography; and selective screening where high-risk diabetics are directly referred to an ophthalmologist and low-risk cases are either left unscreened or are screened by one of the single or combined modality screening options. Given the objective of early detection, effectiveness is assessed in terms of the sensitivity and specificity of the referral decisions of screening options. Both health service and private resource costs of the various screening options are estimated, the latter in terms of travel and the opportunity cost of time. Cost effectiveness is evaluated in terms of the expected cost per true positive case of diabetic retinopathy referred by the screening options. To narrow the choice between the options, those subject to three-way domination with respect to the three choice variables of sensitivity, specificity and expected cost per true positive are excluded. Amongst the remaining options, the choice is dependent on the trade-off between the higher specifics of unselective single modality screening options and the higher sensitivities and lower expected costs per true positive case detected of combined modality and selective screening options.     

髋关节发育不良的早期筛查现状与筛查网络体系

目前髋关节发育不良(DDH)的筛查模式,包括临床查体筛查、选择性超声筛查及全面超声筛查3种。早期超声筛查诊断DDH,已成为DDH诊断的共识,但是国内外对于DDH早期筛查模式迄今尚不统一。目前,我国部分地区的DDH三级网络筛查是利用现有的"三级卫生保健网",进行转诊-筛查-确诊-治疗的模式,可有效降低儿童期DDH发病率。按照我国卫生与健康相关政策,应建立以基层医疗机构为主导的筛查-转诊-确诊治疗的新型DDH早期筛查网络体系。     

A critical review of periodic health screening using specific screening criteria. Part 4: selected miscellaneous diseases.

Despite the increasing interest in recent years in prevention and early recognition of asymptomatic disease, an objectively based program for periodic health screening of asymptomatic adults has yet to be proposed for the primary care physician. This is the last in a series of four articles which have critically examined the feasibility of screening procedures for 36 selected diseases. Six basic criteria are adopted as necessary to justify periodic screening. Specific screening recommendations are made for each disease, and a longitudinal screening program for asymptomatic adults is proposed. Cost and patient education are two important factors in any viable screening program.     

The state of the organized screening in Hungary in 2006

Hungary carries a heavy burden of cancer. At present, the organized screening of symptomless people seems to be the most promising strategy. According to the state-of-the art, those are the mammography-based breast screening, the cytology screening of cervix uteri, and the colorectal screening using immunochemical detection of the fecal occult blood satisfy the criteria of organized screening. The screening for cancers of the oral cavity, and the methods suitable for early detection of prostate cancer are not based on epidemiological evidence, therefore can only be applied opportunistically, as part of the medical practice. For the time belong, there are no suitable methods for detection of early lung cancer. The organized screening which applies personal call-and-recall has been incorporated in the National Public Health Programme. The concepts underlying the organized screening are fully in accordance with the recommendations by the European Union. The Chief Medical Officers' Office (OTH) is being charged with the organization, coordination and evaluation of organized screening programmes for the above screening modalities. In the past few years, an appropriate system for administration and information (including a country-wide screening registry) has been established, in addition to a regional coordination system based on the institutes of National Public Health and Medical Officers' Service (ANTSZ) and a nation-wide network of mammography and cytological laboratories, capable of meeting the requirements. This publication is to summarize the problems yet to be solved and the results expected from the organized screening programmes.     

Neonatal screening for metabolic diseases: need for efficacy studies

Neonatal screening in the Netherlands was extended in 2007. Twelve of the 17 diseases screened for are metabolic disorders. Only 2 of the metabolic diseases part of the neonatal screening programme in the Dutch population had been studied prior to the introduction of neonatal screening, namely galactosaemia and medium-chain acyl-CoA dehydrogenase (MCAD) deficiency. Short-chain acyl-CoA dehydrogenase (SCAD) deficiency, a metabolic disease not added to the screening, was extensively studied recently. The authors concluded that SCAD deficiency did not meet screening criteria. The efficacy of screening should be investigated, as the screening test and genetic differences in populations make screening unique for each population. Clinical and biochemical phenotype do not always correlate with genotype. Differences in the disease population and the screening population can make decisions with respect to treatment difficult, especially when many more patients are found than expected. Some of these patients might never have become ill and should thus not be treated. Further studies are needed to differentiate between these patients.     

Information about screening – is it to achieve high uptake or to ensure informed choice?

For many years, public information about screening has been aimed at achieving high uptake but concerns are now being raised about this approach. There are several problems that have prompted these concerns. By giving information that emphasizes only the positive aspects of screening the autonomy of individuals is ignored, individuals feel angry when they perceive that they are let down by screening, symptoms may be disregarded because of the belief that screening gives full protection, health service staff carry the blame for problems that are in fact inherent in screening, and sound debate about policy and investment in screening is hampered by misunderstanding about the benefits and costs of screening. If we adopt instead an approach that makes explicit the limitations and adverse effects then a different set of problems will be encountered. We risk a reduction in uptake of screening and thus population benefits may reduce, those most likely to be deterred from accepting screening may be the most socially disadvantaged, there will be a cost in terms of staff time to explain screening more fully to participants, and cost‐effectiveness could be reduced if uptake falls so low as to make services barely viable. In the UK current General Medical Council (GMC) advice ¹ to doctors about informed consent for screening makes it clear that full information should be given. The UK National Screening Committee has also signalled the need for a changed approach to information ² giving so that individuals are offered a choice based on appreciation of risks and benefits. It will take time for this approach to be fully reflected across the full range of UK screening programmes. New national information will be needed to assist staff in giving full information, and some aspects of policy, such as screening coverage targets for Health Authorities and General Practitioners, will need to be altered. There are many questions still to be answered about the kind of information needed to achieve informed participation, and about how it should be framed and communicated. These questions can begin to be addressed when there is clarity at national level about the purpose of information about screening.     

Prenatal screening and genetics.

Although the term 'genetic screening' has been used for decades, this paper discusses how, in its most precise meaning, genetic screening has not yet been widely introduced. 'Prenatal screening' is often confused with 'genetic screening'. As we show, these terms have different meanings, and we examine definitions of the relevant concepts in order to illustrate this point. The concepts are i) prenatal, ii) genetic screening, iii) screening, scanning and testing, iv) maternal and foetal tests, v) test techniques and vi) genetic conditions. So far, prenatal screening has little connection with precisely defined genetics. There are benefits but also disadvantages in overstating current links between them in the term genetic screening. Policy making and professional and public understandings about screening could be clarified if the distinct meanings of prenatal screening and genetic screening were more precisely observed.     

Cervical screening interval: costing the options in one health authority.

BACKGROUND: This is a study of the costs of the cervical screening programme in one health authority with a mixed three and five year, and thus inequitable, cervical screening interval. The costs of three year and five yearly screening are compared, and considered in terms of likely numbers of averted cases of and deaths from cervical cancer. METHODS: The study uses an activity-based costing procedure to calculate the component and total costs of the cervical screening programme. RESULTS: The main costs of the cervical screening programme are the costs of taking and processing smears. In 1994-1995 the total cost of a three year recall policy was 768 570 pound silver per 100000 eligible women and that of a five year recall policy was 476768 pound silver per 100000 eligible women. Best estimates of the numbers of cases of and deaths from invasive cervical cancer averted by three over five yearly screening are 1.4 and 0.7 per 100000 eligible women, respectively. Because of uncertainty regarding colposcopy costs a sensitivity analysis was carried out, giving a range of cost differences between three and five yearly screening of 278477 pound silver and 351 768 pound silver. CONCLUSIONS: The health service costs of three yearly screening are considerably greater than those of five yearly screening. Despite this, a significant proportion of smear-takers are screening more frequently than five yearly, with implications for anxiety of screened women, as well as health service costs.     

Congenital toxoplasmosis: to screen or not to screen?

We have reviewed the present day quantifiable cost to society of the 73 cases of congenital toxoplasmosis which are estimated to occur annually in Scotland with the cost of preventing the disease by screening and treatment. Our analysis includes advances in laboratory techniques. The cost of screening would depend on its scale and if in-house or commercial tests are used. If only 2 specimens were screened, at booking and at delivery, the screening costs are estimated to be between 0.5-0.9 times the preventable costs. If a third specimen were tested in the second trimester, to maximise scope for remedial action during pregnancy, the screening costs are 0.7-1.2 times preventable costs. As likely screening costs in most of the schemes we consider are now less than the preventable costs, a screening programme should be adopted.