山东省基层医疗机构中医服务项目成本测算研究

目的了解山东省基层医疗机构中医服务项目成本现状,分析制约基层医疗机构中医事业发展的原因,为中医事业的发展提供建议。方法采用分层抽样的方法在山东省内选取调查样本,用完全成本测算法进行成本测算。结果村卫生室、乡镇卫生院、县中医院和县人民医院三级四类医疗机构开展的中医服务项目中亏损项目比例分别达到了46.90、36.30、39.10和41.90,亏损项目服务量都比较大;其中,中医针灸、推拿和中医外治类等类型服务项目亏损尤为严重。结论中医服务项目存在着普遍亏损现象,中医服务人员的技术劳务价值未能得到充分体现。     

医院成本管理浅析

一、医院的成本管理成本是医院为病人提供各种医疗服务所消耗的物化劳动和活劳动的货币表现，是医疗活动过程中所消耗的各项费用总和。从成本特性看，成本可分为固定成本（成本总额在一定时期和一定医疗服务量的范围内，不随服务量增减而变动的成本）、变动成本（成本总额随医疗服务量增减而变动的成本）、半固定成本或半变动成本（兼有固定成本和变动成本性质的成本）。从医疗业务收支分类看，成本可分为管理成本、医疗成本、药品制剂生产成本。从整个医疗服务内容看，成本又可分为各单个项目成本（以医疗服务项目为计算对象的成本）。医院…     

江西省两所医院固定成本和变动成本的比较分析

通过对江西省两所三甲医院及样本科室固定成本和变动成本的比较分析发现：在两院医疗服务总成本中固定成本所占比例较高在固定成本构成项目中，购置费和固定劳务费所占比例较高；在变动成本构成项目中，卫生材料费和变动工资所占比例较高；在科室变动成本中除上述两项成本外，检验科室分摊的手术费等在总变动成本中所占比例也较高针对上述结果提出各项成本控制措施。     

医院医疗服务固定成本与变动成本分析

医院总成本在短期内可以分为两部分，固定成本和变动成本。固定成本是不随医院提供服务量变化而变化的成本，它和服务量无关，不管医院是否提供服务量，还是提供多少服务量，医院都必须支付这部分成本。变动成本随着医院服务量的变化而发生变化，当服务量为零时，变动成本也为零；如果服务量增加，变动成本也增加。本大利用医院之间横断面资料，对固定成本、变动成本、平均固定成本和平均变动成本进行分析和比较，以揭示各医院要素投入的构成，并作政策讨论。因缺乏医院纵向的成本资料，影响了对边际成本及各类成本之间关系的讨论。1材料与…     

我国公立医院医疗服务项目收费偏离成本情况分析

目的:通过测算公立医院医疗服务项目成本,探究当前我国公立医院医疗服务收费不合理的程度,并提出相应的政策建议。方法:从全国医疗服务成本测算数据库中,按照地域分布和数据质量高的原则,选择了山东、浙江、安徽、陕西和云南5省的省、地市、区县级医院作为研究样本;采取阶梯分摊的全成本测算法测算36家医院3 488个医疗服务项目的成本,比较分析各类服务项目中能够收回成本的项目数所占比重,并拟合各类项目的成本收费比值频率分布图。结果:只有医技诊疗类中的超声检查、医学影像类服务项目的收费总体上能收回成本,其他类服务项目的收费总体上不易收回成本;各类服务中,收费低于成本与收费高于成本的项目同时存在。结论:降低医学影像、超声检查类项目的收费,适当提高能高度反映医务人员技术劳务价值项目的收费标准;增强成本测算在医疗服务定价过程中的指导作用,积极采用更先进的支付方式。     

重庆市中医医疗服务项目收费及成本核算的调查研究

目的 :通过对重庆市中医医疗服务项目收费现状及成本进行调查,为医疗服务价格调整和方案制定提供决策依据。方法 :采用《中医医疗服务项目价格调查表》和《重庆市增补医疗服务项目成本测算表》对9所中医临床服务机构进行价格和成本调查,以SPSS软件进行数据处理和统计分析。结果 :重庆市中医医疗项目收费价格普遍偏低,中医类手术、治疗项目收费标准大部分低于50元;50%以上的项目成本核算价是目前收费价格的2倍以上。结论 :目前重庆市中医项目数量偏少,不能满足广大患者的需求;现行中医医疗服务项目价格偏低不能调动医务人员积极性,亟需调整价格、建立科学合理的中医服务价格体系。     

非营利性综合医院年度固定资产投资评价方法的研究

目的:用本量利(成本、数量和利润)理论的安全边际分析方法,建立区域非营利性综合医院年度固定资产投资评价方法,来评价其固定成本和经营效率的高低,并据此判断下一年度非营利性综合医院固定资产投资.方法:运用本量利的数学模型,分析某市区域内四家三级非营利性综合医院A、B、C、D的12年历史资料.设定医院A、B、C、D的平均医疗服务单位价格、平均医疗服务单位变动成本为"标准"医疗服务单位价格、 "标准"医疗服务单位变动成本,以此计算各医院的"标准"安全边际率.用各医院的"标准"安全边际率是否＞0,来判断各医院的医疗服务单位固定成本是否"超标",反映医院相对于区域内同级医院的固定成本和经营效率的高低.结果:在12个评价年度的医疗服务单位固定成本和经营效率两方面,医院A最好,C次之,B再次,D最差.结论:利用"标准"安全边际率是否＞0,判断区域内各医院的医疗服务单位固定成本是否"超标".通过"标准"安全边际率是否＞0与财政年度固定资产"专项补助"的联动,来决定是否给该院的年度固定资产投资,优化区域卫生资源配置,提高医院经营效率.     

长三角地区医疗服务项目价格结构比较研究

目的:探索长三角地区医疗服务项目价格结构的差异,为推进医疗服务价格的宏观调整提供依据。方法:收集长三角各地2021年医疗服务项目价格目录,筛选300项代表性项目作为研究样本。采用核密度估计和Meta分析方法,纵向比较和分析长三角地区医疗服务项目比价关系的差异。结果:总体上,各地医疗服务项目的价格结构均呈偏态分布,上海市整体价格水平高于其他地区。按类别比较,浙江省综合医疗服务类项目的比价关系相对较大,江苏省医技诊疗类、临床诊疗类项目和上海市中医诊疗类项目的比价关系相对较小。结论:地区间医疗服务整体价格水平差异符合经济发展情况,各地应重视调整医疗服务中比价关系差异较大的项目,保持地区间比价关系一致性。上海市应重点调整中医诊疗类项目,突出中医药重要地位,保障中医药长期高质量发展。     

样本地区县级妇幼保健机构院外群体保健服务项目成本构成分析

目的:了解广东省、湖南省、云南省3个样本县妇幼保健机构群体保健服务项目成本构成情况。方法:利用全成本测算方法,对3个县级妇幼保健机构院外群体保健服务项目的成本进行测算。结果:样本地区县级妇幼保健机构群体保健服务项目成本消耗以人员经费和直接工作经费为主,占总成本的比例65%以上。不同样本地区的群体保健服务项目的成本存在差异,广东样本县服务项目的成本要比湖南样本县和云南样本县高。结论:为保障我国妇幼卫生群体保健服务项目工作得到很好的落实,对人工经费和直接工作经费的重视不容忽视;东部样本县成本比西部样本县要高,这可能与当地经济水平、工作任务的完成程度等存在一定关系。     

省域基本公共卫生服务成本效果分析和TOPSIS法综合评价:以湖北省为例

目的:综合评价省域基本公共卫生服务项目绩效,对进一步完善基本公共卫生服务项目、科学合理评价项目执行状况提出可行的政策建议。方法:采用分层随机抽样,通过机构调查获取湖北省样本地区基本公共卫生服务信息系统数据资料;通过查询政府网站获取相关政策文件;通过专家咨询筛选评价指标,并结合层次分析法确定各指标权重,同时分别运用成本效果分析和加权TOPSIS法,纵向和横向比较评价样本地区基本公共卫生服务项目绩效。结果:实际人均项目补助标准偏低;部分项目成本效果有所改善,尤其是慢性病患者规范化健康管理;各县区基本公共卫生服务项目绩效差异较大,Ci值最高为0.781 1,最低仅为0.269 4。结论与建议:将流动人口纳入基本公共卫生服务经费预算范围,建立动态增长机制;优化基本公共卫生服务绩效考核方案,综合运用成本效果分析和TOPSIS法,通过纵向和横向分析相结合的方法,克服单一方法不足;加大财政投入,推进基层医疗卫生服务体系建设。     

Trends in meningococcal disease in Italy in 1988

Meningococcal disease in Italy decreased 15% in 1988 from the previous year (290 vs. 342 cases). The decline was particularly evident in military cases (1.7/100,000 in 1988 vs. 5/100,000 in 1987) reflecting the full coverage of bivalent serogroup (A + C) meningococcal polysaccaride vaccine in army recruits, achieved since January 1988. The highest proportion of cases was seen in people older than 25 years of age (25%). Serogroup C constituted 60% of the isolates, while 19% belonged to serogroup B. The proportion of strains resistant to sulphonamides was 45%, while 15% were resistant to Minocycline and none to Rifampin. Out of the five military cases, only one (due to serogroup C) was attributable to the vaccine failure. A single coprimary case, but no secondary cases occurred among civilians. These findings are consistent with the trends reported in Italy in the previous years.     

Benzene in blood and phenol in urine in monitoring benzene exposure in industry

Determinations of benzene concentration in blood and of phenol in urine were made by head-space gas chromatography techniques on samples taken near the end of the work day from two groups of workers potentially exposed to low levels of benzene in the work-place atmosphere. Preliminary results suggest that benzene in blood is more reliable than phenol tests for assessing both exposure and uptake of benzene. Normal values of phenol in urine (10 mg/liter or less) were found in nearly all those cases in which benzene was detected in the blood.     

Changes in immune function in asthma in the elderly

Asthma is an inflammatory disorder of the airway. The airway inflammation of asthma is typically an allergic inflammation characterized by cells and mediators described as a "Th2" inflammatory response. There is a growing body of evidence describing changes in the function of immune cells upon aging, a phenomenon referred to as "immunosenescence". Several studies utilizing animal models and human subjects with asthma have begun to explore age-related effects on the airway inflammation in asthma. This review explores the existing data on the presence and effects of immunosenescence or age-related changes in immune function in asthma.     

Changes in Fatty Acid Composition in Beef in Italy

Results from a study conducted in Italy concerning the updating of composition data of beef consumed in Italy are reported here. The study required a very wide sampling plan with regard to both animals and cuts to analyse. Data related to lipid composition of the most widely used type of beef consumed in Italy (young bull, 16–22 months old) show a reduction in total lipid content (which, according to the cuts, ranges between 1.8 and 10.2%) and a substantial change in fatty acid composition, with a high % of polyunsaturated fatty acids (mean 20% of total fatty acids). Such data have been confirmed by other studies conducted in Italy, and are in contrast with data reported in the tables of food composition from other countries, reporting a fatty acid composition characterized by a high fatty acid saturation degree. The occurrence of long-chain polyunsaturated fatty acid is probably due to the high ratio of phospholipids: triglycerides, occurring when the content in intramuscular lipid is very low; to the young age of animals; to the reduced activity of the rumen, where saturation of fatty acids occurs. It may be concluded that a fatty acid composition, which is particularly rich in polyunsaturated fatty acids, seems typical for Italian products.     

2015年郑州市饮用水放射性水平状况调查

目的了解郑州市不同地区、不同季节、不同水源类型的放射性水平。方法分别于丰水期和枯水期采集郑州市区黄河水源水、井水源水、丹江口水源水、出厂水和末梢水各一份;以县为单位,每单位采集出厂水、末梢水、水库水、河水、井水各1份,按《生活饮用水生活标准检验方法》(GB/T 5750.13-2006)检测饮用水中总α和总β放射性水平,依据《生活饮用水卫生标准》(GB 5749-2006)进行判定。结果丰水期、枯水期水体总α、总β放射性水平均低于国家标准限值。结论郑州市不同水源类型均处于正常的天然放射性本底水平。     

Occupational stress in nurses in psychiatric institutions in Taiwan

Nurses are known to be exposed to occupational stress. However, occupational stress is not well documented for nurses in psychiatric institutions in Taiwan. A cross-sectional study was conducted to explore the work-related stress and risk factors of nurses in psychiatric institutions in Taiwan. A structured questionnaire was distributed to nurses at five state-owned psychiatric hospitals in Taiwan in 2001. Demographic information, working environment, and personal health status were inquired. Occupational stress was assessed based on the Chinese version of Job Content Questionnaire (JCQ). General health status and mental health were evaluated by the International Quality of Life Assessment Short Form-36 (IQOLA SF-36). A total of 573 questionnaires were disseminated to nurses and 518 (90.4%) were satisfactorily completed by nurses, including 408 female full-time nurses who had been in their current work for more than 6 months. In the past one month, 17.2% of nurses reported being under significant stress often or always. Assault episodes were reported by 45.1% of nurses in the past 6 months. Among the nurses, 16.9%, 25.2%, 50.0%, and 7.8% belong to the "High strain", "Low strain", "Active", and "Passive" groups, respectively. Perceived occupational stress was associated with young age, widowed/divorced/separated marital status, high psychological demand, low workplace support, and threat of assault at work. Lower general health score was associated with low job control, high psychological demand, and perceived occupational stress. A lower mental health score was associated with low job control, high psychological demand, low workplace support, and perceived occupational stress. We concluded that nurses in psychiatric institutions are under significant stress related to work factors.     

Changes in nursing administration in supporting transplantation in Brazil

This historical and bibliographic study aimed to understand how Nursing was organized to support care in transplantation. The HISA, LILACS, BDENF, PERIENF and DEDALUS databases were consulted, and thirteen references were found, ten of which were scientific articles, two were master's dissertations and one was a doctoral thesis. The span of time chosen for study ranges from the date of the first kidney transplant in Brazil (1965), to the date of publication of the last scientific article found in the databases mentioned above (2003). After reading these articles, the ones that were similar in topic were grouped together, thus creating the thematic axis for the presentation of the results. The results showed that the Nursing profession has played an important and active role in transplants ever since the first procedure in 1965.