部队卫生服务现状与一体化卫勤保障模式认知调查

目的：对部队卫勤体制和官兵卫生服务需求情况调研,改善部队官兵就医现状,优化部队卫勤体制。方法对不同地区的各类部队人员和医务人员发放卫勤体制问卷,对调研结果进行描述性统计分析。结果进一步明确部队和医院的隶属关系、端正医院的服务方向、提升部队卫生人员素质、改善医疗设备、将医院纳入部队管理体制、强化部队医院对部队的服务意识是切实改善现状、保障官兵卫生服务需求的有效措施。一体化卫勤保障模式具有较高的认可度和可行性。结论部队官兵对部队卫生服务的总体评价较好,但联勤医院服务保障体系需完善,医疗技术水平、就医顺畅程度、全方位医疗服务、一体化卫勤保障等方面有待提升。     

广西两县卫生服务整合及其影响因素研究

目的从医疗卫生服务提供者视角对两县的医疗卫生服务体系县域内整合现状进行评价和分析并提出相应的政策建议。方法以卫生服务整合理论为基础、选取彩虹模型作为分析框架,将彩虹模型量表得分进行百分制转化进行描述性分析和回归分析。结果两试点县在以人和社区为中心和机构文化两个维度得分较高,其次是服务整合和技术能力,在组织整合维度得分较低,专业整合维度得分最低。其中,县医院在以人和社区为中心、服务整合、专业整合和机构文化四个维度得分最高,公共卫生机构在这四个维度得分最低;基层医疗机构在技术能力维度得分最高。医疗机构的各维度的整合服务评分与医务人员的学历、是否全科医生和职工满意度有关。结论县域医疗机构要以政府为主导,完善基层人才培养体系,从而落实县域医共体建设,推动医防融合,以进一步提高医疗机构服务整合程度,增强医务人员满意度。     

The walk-in chains: the proprietarization of ambulatory care

In this article we examine the previously little-studied development in U.S. health care--the growth of a proprietary ambulatory care system composed of health maintenance organization, urgent care centers, ambulatory surgicenters, ambulatory diagnostic centers, large group practices, and other delivery modalities. The growth of this system as a result of the ease of access to capital, limited or nonexistent regulation through Certificate of Need or other mechanisms, the growing surplus of physicians, decreases in the use of hospitals as a result of changed insurance benefits and inpatient utilization review, new developments in biotechnology, and computerization and miniaturization of new technological advances is discussed. The reasons for the expanded growth of proprietary chains over nonprofit systems of ambulatory care are also discussed. The article concludes with a discussion of the negative consequences for individual health and the health care system that may be generated by the continued growth of proprietary ambulatory care.     

Determinants of integrated health care development: chains of care in Sweden

Local health care in Sweden is an emerging form of integrated care, linked together by chains of care. Experiences show, however, that the development of chains of care is making slow progress. In order to study the factors behind this development, an embedded multiple-case study design was chosen. The study compared six health authorities in Sweden, three with successful and three with unsuccessful chain of care development. Three major determinants of integrated health care development were identified: professional dedication, legitimacy and confidence. In more detail, space for prime movers and trust between participants were crucial success factors, while top-down approaches targeting at the same time a change of management systems were negative for the development of chains of care. Resistance from the body of physicians was a serious obstacle to such a development. Local health care depends on developed chains of care, but it seems that health care managers do not have the management systems necessary to run these clinical networks, mainly due to a lack of acceptance from the medical profession. This is an impossible situation in the long run, since the number of chains of care is likely to increase as a result of the emerging local health care.     

The role of home care in integrated delivery systems.

The health care field is moving rapidly toward integrated delivery systems (IDS). The role of home care in such system is unclear. This study seeks to describe the current status of home care in IDS and to examine health care administrators' perceptions about the importance of IDS components. A random sample of 1600 administrators was surveyed, 400 each from home care agencies, hospitals, nursing homes, and medical groups. Results reveal that hospitals lead integration, nursing homes are least involved, and home care agencies and medical groups fall in between. Administrator's opinions vary considerably about the importance of select services and integrating mechanisms.     

A Central Supply Technician Training Program: From a Dream to a Reality

Decreased public funding, a competitive healthcare market, and higher patient care costs have been blamed for the present financial challenges that confront academic health centers. The authors examined the costs associated with graduate medical education, particularly, indirect medical education expenses in the operating room. The results indicate that it is more costly for teaching hospitals to provide surgical care to patients in the operating room. The academic health center's indirect graduate medical expenses only covered a portion of the increased costs. If the missions of academic health centers are perceived as a public good, policy makers must design a system that more appropriately compensates academic health centers for the additional costs associated with surgical procedures in graduate medical education.     

Cost differences between academic and nonacademic hospitals: a case study of surgical procedures

Decreased public funding, a competitive healthcare market, and higher patient care costs have been blamed for the present financial challenges that confront academic health centers. The authors examined the costs associated with graduate medical education, particularly, indirect medical education expenses in the operating room. The results indicate that it is more costly for teaching hospitals to provide surgical care to patients in the operating room. The academic health center's indirect graduate medical expenses only covered a portion of the increased costs. If the missions of academic health centers are perceived as a public good, policy makers must design a system that more appropriately compensates academic health centers for the additional costs associated with surgical procedures in graduate medical education.     

How five leading safety-net hospitals are preparing for the challenges and opportunities of health care reform

Safety-net hospitals will continue to play a critical role in the US health care system, as they will need to care for the more than twenty-three million people who are estimated to remain uninsured after the Affordable Care Act is implemented. Yet such hospitals will probably have less federal and state support for uncompensated care. At the same time, safety-net hospitals will need to reposition themselves in the marketplace to compete effectively for newly insured people who will have a choice of providers. We examine how five leading safety-net hospitals have begun preparing for reform. Building upon strong organizational attributes such as health information technology and system integration, the study hospitals' preparations include improving the efficiency and quality of care delivery, retaining current and attracting new patients, and expanding the medical home model.     

Developing a Global Health Diplomacy Supply Chain—A Viable Option for the United States to Curb Extremism

This study examines the idea of developing a global health diplomacy supply chain as an important foreign policy approach with the aim of improving the lives of vulnerable populations and serving the best interests of the United States. The study was based on the review of academic literature, news events, and military communiqués, and historical writings were studied to determine the feasibility of the idea and the extent of costs and benefits of such an endeavor. An integrated strategic business model, supported by a medical care delivery process, was developed to create a framework for a feasible global health diplomacy supply chain. The findings indicate that extremism can be contained by creating and efficiently executing an effective supply chain to get medical care units to those that need them. The limitations are the potential exit strategies required, the tactical abilities, and diplomatic techniques needed in order to create positive diplomatic change in aid distribution. Managers must consider how supply chains will affect other organizations giving aid and the potential public response. Moreover, determining the level of care necessary to achieve the greatest positive health diplomacy continues to require vigilant scrutiny over the potential cost/benefit analysis. The analysis is valuable to policymakers considering the impacts of health diplomacy by utilizing supply chain management.     

The academic health center and the healthy community.

US medical care reflects the priorities and influence of academic health centers. This paper describes the leadership role assumed by one academic health center, the State University at Buffalo's School of Medicine and Biomedical Sciences and its eight affiliated hospitals, to serve its region by promoting shared governance in educating graduate physicians and in influencing the cost and quality of patient care. Cooperation among hospitals, health insurance payers, the business community, state government, and physicians helped establish priorities to meet community needs and reduce duplication of resources and services; to train more primary care physicians; to introduce shared governance into rural health care delivery; to develop a regional management information system; and to implement health policy. This approach, spearheaded by an academic health center without walls, may serve as a model for other academic health centers as they adapt to health care reform.     

Health care for the poor: some policy alternatives

Changes in the financing and organization of medical care are most likely to affect adversely the poor who have significant needs for care, but face increasingly stringent eligibility criteria in Medicaid and other public programs. Americans estimated to have neither private nor public health insurance coverage number 33 million persons, and with increased cost pressures, voluntary and proprietary hospitals are less willing to treat such patients. One quarter of hospitals provide 60 percent of all care to the poor, and many of these nonprofit and public hospitals face economic difficulties and an erosion of public commitment. Alternative solutions include publicly subsidized premiums for the poor and near poor and assistance to financially stressed hospitals caring for large numbers of such persons. Mechanisms include all-payer systems, taxes on net hospital revenue or insurance premiums, or contributions from general tax revenues. Financing poses special problems, but it is also necessary to address the special needs of children and the elderly, the appropriate balance between technical and cognitive services, and new ways to maintain health and promote effective functioning. These issues pose challenges and opportunities for family practice.     

Public release of performance data and quality improvement: internal responses to external data by US health care providers

Health policy in many countries emphasises the public release of comparative data on clinical performance as one way of improving the quality of health care. Evidence to date is that it is health care providers (hospitals and the staff within them) that are most likely to respond to such data, yet little is known about how health care providers view and use these data. Case studies of six US hospitals were studied (two academic medical centres, two private not-for-profit medical centres, a group model health maintenance organisation hospital, and an inner city public provider "safety net" hospital) using semi-structured interviews followed by a broad thematic analysis located within an interpretive paradigm. Within these settings, 35 interviews were held with 31 individuals (chief executive officer, chief of staff, chief of cardiology, senior nurse, senior quality managers, and front line staff). The results showed that key stakeholders in these providers were often (but not always) antipathetic towards publicly released comparative data. Such data were seen as lacking in legitimacy and their meanings were disputed. Nonetheless, the public nature of these data did lead to some actions in response, more so when the data showed that local performance was poor. There was little integration between internal and external data systems. These findings suggest that the public release of comparative data may help to ensure that greater attention is paid to the quality agenda within health care providers, but greater efforts are needed both to develop internal systems of quality improvement and to integrate these more effectively with external data systems.     

The impact of DRGs on the health care industry

The impact of Medicare's prospective payment system on hospitals and home care agencies includes significant changes in patient and service mix and quantity as well as rapid entrance of hospitals and proprietary organizations into the home care industry. As a result, many opportunities and challenges confront hospitals and other health care providers.     

The emergence of proprietary medical facilities in China

This paper analyzes the evolution and development of market conditions and government policies that have favored the emergence of proprietary medical facilities in China. Excess and differentiated demand for medical services, the existent profitability and supply of the investment capital in health care market, and favorable government policies have encouraged the entrance of proprietary facilities in health care market. The paper further analyzes why nonprofit health organizations are not an optimal organizational form in the current Chinese health care market. After discussing the strengths and weaknesses of proprietary ownership in health care market in China, the paper concludes with important managerial and policy suggestions.     

Safety-Net Providers In Some US Communities Have Increasingly Embraced Coordinated Care Models

Safety-net organizations, which provide health services to uninsured and low-income people, increasingly are looking for ways to coordinate services among providers to improve access to and quality of care and to reduce costs. In this analysis, a part of the Community Tracking Study, we examined trends in safety-net coordination activities from 2000 to 2010 within twelve communities in the United States and found a notable increase in such activities. Six of the twelve communities had made formal efforts to link uninsured people to medical homes and coordinate care with specialists in 2010, compared to only two communities in 2000. We also identified key attributes of safety-net coordinated care systems, such as reliance on a medical home for meeting patients' primary care needs, and lingering challenges to safety-net integration, such as competition among hospitals and community health centers for Medicaid patients.     

Implementing health information technology to improve the process of health care delivery: a case study.

Integration of health information is critical to the provision of effective, quality care in today's fragmented health care system. The increasing prevalence of chronic conditions and the demand for a comprehensive understanding of patient health on the part of providers are driving the need for the integration of health information through electronic health information systems. Two distinct health information systems currently utilized in the health care field include electronic medical records (EMR) and chronic disease management systems (CDMS). The integration of these systems is likely to enable the efficient management of health information and improve the quality of health care as it would provide real-time patient information in a coordinated manner. The lack of real-time information may result in delayed treatment, uninformed decisions, inefficient resource use, and medical errors. Despite their importance and widespread support, these systems have slow provider adoption rates. Our understanding of how health information technology may be used to improve health care is limited by the relative paucity of research on the adoption, integration, and implementation of these 2 types of systems. This paper documents the use of an EMR at Marshfield Clinic, a multidisciplinary group practice in the United States. We review the concomitant use of an EMR for clinical data capture and the implementation of a proprietary CDMS, InformaCare, for care management of chronic diseases. These 2 systems allow providers to deliver health care using evidence-based guidelines that meet the Institute of Medicine's aim of providing safe, efficient, patient-centered, and timely care.     

基于公益性的我国公立医院公共服务职能探讨

从公益性角度分析并结合我国公立医院公共服务的实践,提出公立医院确保基础医疗服务、提高扶持基层医疗的水平、开展公共卫生和卫生应急服务、控制成本和提供针对弱势群体的医疗服务的公共服务职能,推动公立医院切实履行公益性．为人民群众提供安全、有效、方便、价廉的医疗卫生服务。     

The effect of investor-owned chain acquisitions on hospital expenses and staffing.

Much concern has been raised about the effect of "corporatization" of health through the expansion of investor-owned hospital chains. One method of expansion is through hospital acquisition. At issue is the question of the effect of acquisitions on expenses and on such patient care inputs as staffing levels. In this article, we examine the effect of acquisition by one investor-owned chain on hospital costs and staffing. Subsequent to acquisition, hospital costs increase and staffing decreases, relative to competitor hospitals. However, since investor-owned hospitals not recently acquired do not have higher cost levels than their competitors, the increase in costs appears to be due to factors associated with the acquisition itself rather than factors associated with being an investor-owned hospital. Under the retrospective payment system in effect at the time, revenues also were higher for acquired hospitals. Under prospective payment, increasing revenues has been more difficult, decreasing acquisition incentives.     

Mainstreaming complementary therapies: new directions in health care

Within the past decade, complementary and alternative medicine (CAM) has penetrated mainstream U.S. health care. Major medical journals are publishing research on the efficacy of specific CAM therapies, physicians are attending oversubscribed continuing medical education courses on CAM, and hospitals are offering CAM services, sometimes through outpatient integrative medicine clinics. This paper presents factors behind the growth of CAM, analyzes its relationship with conventional medicine, and suggests how the integration of CAM and conventional medicine can be more effectively guided.     

公立医院筹资补偿机制的探讨

"为群众提供安全、有效、方便、价廉的医疗卫生服务"是<公立医院改革试点指导意见>提出的公立医院医疗卫生服务的总体目标,这一目标的实现仅靠改革公立医院内部运行机制是很难奏效的.公立医院的投入机制、区域医疗卫生服务体系的布局、医院所在地的经济与产业状况、医疗保障(险)的支付额度与支付审批程序等众多因素直接影响医院的投入与产出.本文从我国医院的投入补偿机制入手,分析了医院投入与产出的特征,提出建立基于公益性绩效的公立医院投入补偿的观点,为进一步完善公立医院的管理体制、形成以公益性为导向的公立医院运行机制提供参考依据.