基于多机制框架的县级公立医院补偿机制设计

县级公立医院补偿机制的设计不单纯是一个财务的平衡问题,涉及政府、医保、医院、价格等多方面的机制协调。以公立医院补偿机制改革的经验借鉴为出发点,总结了县级公立医院补偿机制设计的基本逻辑和“多机制框架”。依据激励相容理论,对“多机制框架”下的县级公立医院补偿机制进行了系统设计。     

“总量控制 结构调整”政策与理顺医院补偿机制

“总量控制　结构调整”政策与理顺医院补偿机制王永龙，郑益川，郝模，吴延风，王志锋，王金承，王锦福，刘俊，王龙兴，周剑萍，周海洋，郑树忠＂总量控制、结构调整＂政策，以理顺医院补偿机制为手段，控制医疗费用过快增长和促进医院发展良性循环为目的，迈出了关键的...     

完善医院成本补偿机制初探

我们医改的最终目标是“让群众享有价格合理、质量优良的医疗服务”。公立医院健康运作离不开必要成本的补偿，政府、医保、医院应共同参与建立并完善医院成本补偿机制，使医疗费缺口问题不再困扰医院，为我国实现根治“看病难、看病贵”问题开拓一条蹊径。     

对医院补偿机制设计的新思考

近20年来，我国的医疗卫生体系经历了重大变革，也面临许多问题，包括医疗费用快速上涨、医疗资源的不足和浪费并存、医疗公平性显著降低等，但是更严重、影响更深远的问题则是医患关系持续恶化，社会和病人对医院和医生的不信任和质疑日益增加。所有这些，其根源之一在于自20年前开始对医院补偿机制的改革。由于政府对医院的直接补偿长期远远不足，医院被迫在市场上“逐利”，并让医生逐渐成为了医院的“赚钱工具”。在当时政府财力不足的情况下，这种做法是一种无奈的选择，而且客观上也对医疗卫生事业的发展起到了很大作用，但付出的代价也非常巨大。在当前政府和民间财力相对充裕、努力建设和谐社会的今天，是到了解决这些问题的时候了。而解决这些问题的最佳选择，莫过于改革医院补偿机制，切断医生和医院之间的经济利益联系。     

完善医院补偿机制的策略分析

近几年来，随着我国市场经济体制的建立和完善，“以药补医”政策带来的问题日益突出，越来越成为社会关注的热点。为此，国家也采取了一系列政策和措施，但由于多种原因一直没有从根本上有效解决。因此，制定科学有效的政策措施，切实扭转“以药补医”机制，是摆在我们面前的一项重大课题。解决“以药补医”的前提是完善医院补偿机制。因此，笔者在对全国卫生部门综合医院收入结构变化情况进行分析的基础上，研究探讨了完善医院补偿机制、调整医疗服务价格和财政补助的策略。     

医疗机构补偿机制的分析

目前社会反映“看病贵”而医疗单位却“步履维艰”，亏损单位逐年增多，医疗服务消耗的补偿严重不足，为此笔者对补偿机制作一分析。（一）医疗机构补偿机制的现状１、财政补偿近年来，国家财政对医院的差额补助，从绝对数看每年虽有增长，但占人员经费的比重却逐年下降；国家对医院的基建、添置大型医疗器械的专项补助也越来越少，同时医疗欠费逐年增加，而财政清欠基金拨戳却为零。（见表１）２、市场补偿医疗服务活动的价值补偿，主要依靠市场。近几年来医疗收费标准虽然作了调整，但仍大大低于实际成本。（见表２）（二）完善补偿机制的…     

发达地区医院补偿机制恶性循环定量研究

发达地区医院补偿机制恶性循环定量研究吴延风郝模王志锋信亚东李海宁罗力郑益川邱杨明根据郝模等［１］提出的“医疗费用过快增长作用机制”，依据本课题组研制的“恶性循环定量论证方法”，测算我国发达地区９０年代以来财政补偿不足的状况；以及由此促发的医院医疗行为...     

从管理的封闭原理谈药品的招标采购

1　药品招标采购的由来和背景近年来 ,医院“以药养医”、“药价高”、“药品购销环节层层拿回扣”等现象已是众所周知 ,并成为大众公开的谈资。出现这些问题 ,主要有以下几个方面的原因 :第一 ,医院的补偿机制不合理。在我国现行的财政体制下 ,医院的补偿途径有两条 :一是国家     

控制药品费用总量 促使药品市场有序发展的理论依据和实施效果概述

针对药品市场混乱状况，该课题组经过系统研究形成了“促使药品市场有序发展的政策思路和逻辑顺序”。其中逻辑顺序第一步为：以实施“医疗资源最优利用模型”为前提．控制药品利用总量．该步骤综合分析了药品市场混乱的根源、医院与药品市场的互动关系、药品收益对医院补偿的作用、药品总量和药品扣率间关系等，并在此基础上，得出了上述第一步思路。实践检验表明，该步骤的实施可有效控制药品费用与医院业务收入的过快增长，在促使医院补偿机制进步趋向争理完善的同时，带动了药品数量、品种、价格等适宜性的提高，制药业开始进行结构调整．为避步规范药品市场创造了有利的条件。     

公立医院补偿之路怎么走？——公立医院补偿要分步走

在财政补偿总量不足、补偿结构不明朗的情况下，很多医院出现总体亏损现象。即使像北京朝阳医院一直在市属医院中经济效益比较好，也只能维持收支平衡。 公立医院要做到可持续发展，实现公益目标，需要足够的资金支持。目前，需要财政补助的“盘子”有多大，财政能够往“盘子”里投放多少钱，尚且不清。要改变医院直接从患者口袋里掏钱的运营机制，一味指望财政加大补偿就能万事大吉吗？很多问题值得深思。     

企业职工高尿酸血症与血压、血脂、血糖的相关性研究

目的探讨企业职工高尿酸血症（HUA）与血压、血脂、血糖的相关性,为企业进行健康管理提供依据。方法以中国石油长庆油田公司各下属企业为抽样单位,整群随机抽取2个单位,每个单位中所有的HUA者作为HUA组,共720人;同时在尿酸水平正常者中随机选取620人为正常组。通过Logistic回归分析HUA与年龄、性别、血压、血脂、血糖的关系。结果HUA合并高血压、高血脂、空腹m糖受损任意一项、两项、三项的比例均远高于正常组（OR值分别为：4．036,2．562,4．174）。多因素Logistic回归发现：男性、收缩压、总胆固醇、三酰甘油、低密度脂蛋白胆固醇是HUA的危险因素（OR值分别为7．736,2．309,1．721,2．761,1．411）;高密度脂蛋白胆固醇为HUA的保护因素（OR值为0．211）。结论HUA存在性别差异,且与血压、血脂密切相关。企业对职工的健康管理应充分考虑多危险因素的综合作用,全面的进行健康教育及干预。     

癌缺氧病因及预防和治疗

目的 探讨癌及安阳林州市食管癌高发原因及癌病因预防和治疗措施.方法 对林州市食管癌等疾病现场进行调查,在进行10余年统计分析基础上,综合分析了全国156篇文献成果.结果 提出癌缺氧病因学说,使用制氧机、按摩器、饮用纯净水治疗恶性肿瘤,取得良好效果,改水能够大幅降低林州市居民食管癌发病率、死亡率.结论 癌可能是由于机体长...     

Recruitment and retention challenges and successes

Objective: Addressing health disparities requires well designed, culturally adapted research. However, recruiting/retaining minority participants has often been challenging. We present strategies used to successfully recruit and retain rural Hispanic women during a breastfeeding education intervention.

Design: This study involved a two-group repeated measures quasi-experimental design with assessments at seven intervals between enrollment and 6 months postpartum. Participants (Hispanic women?≥?15 years old) were recruited through a regional hospital.

Results: We successfully met our recruitment goals, most women contacted were enrolled (46 of 58), and 100% completed the study.

Discussion: Research staff with ties within the community helped establish trust. Using bilingual study materials, simple language, and an interpreter addressed language/literacy concerns. Phone assessments facilitated participation as transportation was an issue. Accommodating requests to deliver or mail study materials and providing incentives were important. Extra effort was needed to maintain contact when phone service was disrupted or participants moved. Keys to success were persistence, flexibility, and alleviating barriers to participation.     

初产妇与经产妇焦虑抑郁状态分析及干预

目的：分析初产妇、经产妇心理状态特点,以便采取更有效的干预措施。方法筛选2014年6月至2015年1月在咸阳市旬邑县妇幼保健院产科门诊产前检查的健康初产和经产妇各60名,孕周为28~40周。入组时用焦虑自评量表( SAS)、抑郁自评量表(SDS)对两组孕妇进行心理评定,并给1次支持性心理干预(40~60分钟),1周后再次用SAS、SDS对两组孕妇进行评定分析。结果经产妇干预前SAS(50.73±3.45)、SDS(49.13±3.86)评分明显高于初产妇SAS(42.45±2.08)、SDS(41.77±2.21),差异均有统计学意义(t值分别为-15.921、-12.817,均P<0.01);干预后两组SAS、SDS评分均比干预前明显降低,差异均有统计学意义(t值分别为14.999、15.413;15.724、15.832,均P<0.01);干预后经产妇 SAS(38.61±5.02)、SDS(39.10±3.03)评分明显高于初产妇SAS(34.88±3.31)、SDS(32.01±4.27),差异均有统计学意义(t值分别为-4.805、-10.489,均P<0.01)。结论初产妇和经产妇均伴有焦虑、抑郁情绪,干预前后经产妇抑郁、焦虑情绪均较初产妇明显,支持性心理干预能有效改善孕妇的不良情绪。     

Continuity and change in neighborhood disadvantage and adolescent depression and anxiety

We used data from the Fragile Families and Child Wellbeing Study which includes a sample of adolescents of age 15 at the most recent wave (between 2014 and 2017) from mainly low-income urban families in the United States, to examine the association between neighborhood poverty entries and exits and adolescent depression and anxiety. In addition, we examined whether these associations differed by gender. Adolescents who consistently lived in disadvantaged neighborhoods had the highest level of depression and anxiety. Those who entered poor neighborhoods were more depressed than those who never lived in poor neighborhoods. Those who exited poor neighborhoods showed no significant difference in depression and anxiety compared to those never lived in poor neighborhoods. Furthermore, these associations applied to adolescent girls only and were not statistically significant for boys. The results suggest that neighborhood poverty has cumulative negative impacts on adolescent mental health and disproportionally affects adolescent girls. Reducing neighborhood poverty would substantially improve the health of adolescents, especially girls, which would reduce health disparities.     

Enabling positive change: Progress and setbacks in HIV and sexual and reproductive health and rights

At a point in history when the future of sexual and reproductive health including HIV looks particularly uncertain, it is helpful to recognise that many of the challenges currently faced are neither new nor insurmountable. Reflecting on past achievements and lessons learned helps us to have confidence that positive change is feasible. This paper reflects on some of the changes observed in countries like India and Mozambique and identifies a range of factors which need to coalesce to enable these developments, along with specific contextual factors. It is the combination of these influences rather than any one of them alone that brought about the change in the three instances described – fostering a positive political response to HIV in its early years in India; bringing about policy reform on abortion in Mozambique; and increasing contraceptive prevalence and age at marriage in some districts in Bihar, India. Change is always fragile and susceptible to setbacks, but change-seekers can learn in the process and gain renewed hope that progress can and often does take place if they persevere.     

儿童青少年超重肥胖评价方法及SPSS和SAS实现

超重肥胖已成为世界各国儿童青少年面临的重大公共卫生问题之一。现行的儿童青少年超重肥胖筛查标准不统一,逐条评价或自行编写程序容易出错且效率较低。本研究以中国学龄儿童青少年超重与肥胖筛查标准为例,详细介绍了国际和中国共四种评价儿童青少年超重肥胖的方法和步骤,结合具体案例详细介绍其应用方法,同时编制SPSS和SAS程序包和解...     

Car ownership and the association between fruit and vegetable availability and diet

Objective

Nearly all research on the food environment and diet has not accounted for car ownership — a potential key modifying factor. This study examined the modifying effect of car ownership on the relationship between neighborhood fruit and vegetable availability and intake.

Methods

Data on respondents' (n = 760) fruit and vegetable intake, car ownership, and demographics came from the 2008 New Orleans Behavioral Risk Factor Surveillance System. Shelf space data on fresh, frozen, and canned fruits and vegetables were collected in 2008 from a random sample of New Orleans stores (n = 114). Availability measures were constructed by summing the amount of fruit and vegetable shelf space in all stores within defined distances from respondent households. Regression analyses controlled for demographics and were run separately for respondents with and without a car.

Results

Fruit and vegetable availability was positively associated with intake among non-car owners. An additional 100 m of shelf space within 2 km of a residence was predictive of a half-serving/day increase in fruit and vegetable intake. Availability was not associated with intake among car owners.

Conclusions

Future research and interventions to increase neighborhood healthy food options should consider car ownership rates in their target areas as an important modifying factor.