线性支出系统(LES)与基本医疗界定

界定职工基本医疗的范围与水平，关系到职工健康和医疗费用控制，是维持医疗保障制度正常运行的关键环节。在我国由于对基本医疗的确切内涵还缺乏深入研究，加之我国地区之间、城乡之间经济发展水平差异很大，不同人群享受医疗保健制度及卫生需求各异，卫生资源配置不太合理，利用效率低下，加上研究方法还有不少问题，基本医疗界定仍然存在着很大困难，尤其是界定的理论基础、界定方法和可操作性都很差。本文拟就基本医疗费用界定方法进行探讨。引入线性支出系统估计城市职工的基本医疗费用；对西安市碑林区公费医疗费用资料进行模型拟合，…     

补充医疗保险有关问题的探讨

国务院《关于建立城镇职工基本医疗保险制度的决定》（以下简称《决定》）指出，医疗保险制度改革的主要任务是建立城镇职工基本医疗保险制度。由于是基本医疗保险，因此在《决定》中对基本医疗又提出了“最高支付限额原则上控制在当地职工年平均工资４倍左右，……超过最高支付限额的医疗费用，可以通过商业医疗保险等途径解决。”换言之，超过最高支付限额的医疗费用，通过补充医疗保险来解决。本文就补充医疗保险的界定、支付限额、基金标准、筹资渠道等有关问题作一探讨，与同道研讨。　一、补充医疗保险的界定及最高支付限额所谓补充医…     

职工医疗保障制度改革四年来的回顾与展望

从建立新型的医疗保健制度,保障职工的基本医疗需求,遏制医疗费用过快增长的势头,职工个人帐户资金的积累,职工对新的医疗保障制度的满意度,深化医院内部改革,规范医疗行为等方面对镇江市职工医疗保健障制度改革的四年来的进展情况进行了回顾。     

建立上海职工医疗保险制度的基本思路

一、职工医疗制度改革的指导思想职工医疗制度改革，必须从实际出发，与社会经济发展水平和各方面的承受能力相适应，以保障职工的基本医疗权利为基础，形成多层次的职工医疗保障制度。职工医疗制度改革，必须符合建立社会主义市场经济体制的要求。扩大职工医疗社会保障的覆盖面；建立稳定的医疗社会保障基金，实行国家、单位和个人合理负担医疗费；逐步提高职工医疗经费管理的社会化程度，增强抗风险能力，逐步减轻企事业单位的社会负担，促进企业转换机制、平等竞争和劳动力的合理流动。职工医疗制度改革，必须建立有效的医疗费用控制机制…     

一所高校职工门诊医疗费用分析

目的：通过对某高校医改后职工门诊医疗费用的分析．探讨如何保障职工的医疗水平。方法：对某高校2002—2005年度职工门诊医疗费用数据利用分类测算、文献查询法进行分析。结果：在门诊医疗费用中药费占绝大比重．退休职工的医疗服务需求明显高于在职职工。结论：设立医疗补充基金对城镇职工基本医疗保险制度是一种有益补充,为了控制医疗费用的增长．应建立一套完善的监督机制。     

上海市职工医疗制度现状与对策研究（下）

四、职工医疗制度改革设想(一)改革的指导思想与原则职工医疗制度改革必须以保障职工的基本医疗需求,有利于职工身体健康,促进生产力发展为根本目的;以强化管理,节约开支,克服浪费,有效地利用卫生资源为中心;逐步建立起符合我国国情,与多种经济形式、多种分配方式以及有计划的商品经济相适应,费用由国家、集体、个人合理负担,社会化和多层次的职工医疗保障制度。职工医疗制度改革应遵循以下原则:     

试论医疗保险制度改革中合理控制医疗费用支出的问题

自从国务院在“两江”实施了医疗保险制度改革以来，全国已有５０多个城市开展了医改试点工作。在新的医疗保障制度中，如何合理控制医疗费用的支出，抑制医疗费用的过快增长，保障职工的基本医疗是医改中一个十分重要的问题，本文就此问题进行探讨。１建立科学的医疗费用...     

浅议医改后医院新的医疗违规行为及对策

我国的医疗保障制度改革,确定了“低水平,广覆盖”的基本医疗保险制度,目的在于保障职工的基本医疗待遇。新的制度对医疗费用有了较强的控制措施,要求医院和医生昼理为病人提供优质低价的卫生服务,让有限的卫生费用使更大的人群受益。医疗保障制度的改变,使得医院的行为也会发生相应改变,在这种变化中,要谨防新的医疗违规行为的产生。     

浅议医改后医院新的医疗违规行为及对策

我国的医疗保健制度改革,确定了“低水平,广覆盖”的医疗保险制度,目的在于保障职工的基本医疗待遇。新的制度对医疗费用有了较强的控制措施,要求医院和医生尽量为病人提供优质廉价的卫生服务,让有限的卫生费用使更大的人群受益。医疗保障制度的改革,使得医院的行为也会发生相应改变,这种变化中,要谨防新的医疗违规行为的产生。     

社区卫生服务与城镇职工基本医疗保险制度改革的互动作用

通过对我国部分城市的专题调查研究,对社区卫生服务与城镇职工基本医疗保险制度改革的互动作用进行分析,认为：社会卫生问题决定了医疗保险体制改革必须与卫生体制改革相配套;医疗保险制度改革控制医疗费用的最有效方法是合理引导参保职工利用卫生服务;社区卫生服务在功能合理定位的基础上,争取城镇职工基本医疗保险的政策倾斜与支持是其发展的关键。     

The purpose of occupational medicine.

The purposes of occupational medicine are described in terms of its clinical medical, environmental medical, research, and administrative content. Each of these components is essential in different proportions in comprehensive occupational health services for different industries, and can only be satisfactorily provided by occupational physicians and occupational health nurses who are an integral part of their organizations. Two-thirds of the working population in the United Kingdom are without the benefits of occupational medicine. The reorganization of the National Health Service and of local government presents the opportunity to extend occupational health services to many more workers who need them. It is suggested that area health authorities should provide occupational health services for all National Health Service staff and, on an agency basis, for local government and associated services, eventually extending to local industry. Such area health authority based services, merged with the Employment Medical Advisory Service, could conveniently then be part of the National Health Service, as recommended by the British Medical Association, the Society of Occupational Medicine, and the Medical Services Review Committee.     

黄石市3家企业职工职业卫生服务认知现状调查

摘要:目的　了解企业职工对职业卫生服务的认知状况,并分析影响职工职业卫生服务认知的因素。方法　采用系统抽样选择湖北省黄石市3家企业的90名职工为调查对象,并以问卷调查了解职工对职业卫生服务的认知情况;采用EpiData 3.1建立数据库,运用SPSS18.0软件对数据资料进行描述,并以χ2检验作统计分析。结果　约75%的职工知晓工作中所接触的职业性危害因素,只有50%的职工知晓职业性危害因素的检测浓度,且仅有33.0%的职工在工作企业接受过职业卫生相关知识培训;月收入、户籍状况和企业及工会对职工进行职业卫生服务的宣传力度是影响职工职业卫生服务认知率的主要因素;随着月收入的增加,职工对应签订劳动合同、缴纳保险金及进行职业健康监护的知晓率也随之增高。结论　企业应当定期对职工进行职业性危害因素浓度监测和作业人员的职业健康检查,发现问题、及时整改;同时应针对不同层次的企业职工开展多元化的职业卫生健康宣传和教育工作,加强企业的监管力度,以保障职工对职业有害因素的知情权,提高工人职业卫生服务认知总体水平。     

A Social Work Perspective on Ethical Practice in End-Stage Renal Disease

Social workers increasingly are defining problems that they encounter in practice in health settings as ethical dilemmas. A distinction is made between those practice questions that can best be answered by an appeal to theoretical or empirical knowledge and expertise (clinical questions) and those with invoke values and ethical imperatives (ethical questions). End-stage renal disease poses in high relief the practice dilemmas that are encountered by social workers and offers an opportunity to explore and clarify issues resolving them. Using an exchange framework as a basis for analysis, common ethical problems of end-stage renal services are discussed.     

Gender-based barriers to primary health care provision in Pakistan: the experience of female providers

In common with several countries in South Asia, the Pakistan government health system has introduced cadres of community-based female health and family planning workers as a response to gender-based constraints on women's access to services. However, the recruitment, training and retention of such female workers has been difficult. This finding points to the obvious but neglected fact that female health workers must operate within the same gender systems that necessitate their appointment in the first place. The present study used qualitative methods to increase our understanding of the experience of female staff working at the community level and in particular the gender-based constraints that they face. Important problems identified include: abusive hierarchical management structures; disrespect from male colleagues; lack of sensitivity to women's gender-based cultural constraints; conflict between domestic and work responsibilities; and poor infrastructural support. The findings highlight the interconnectedness of women's public and private lives and the interplay of class and gender hierarchies in the patterning of women's employment experiences. The study's conclusions suggest ways in which the organizational functioning of the government health services might be modified to better facilitate the work of female staff.     

Barriers Faced by the Health Workers to Deliver Maternal Care Services and Their Perceptions of the Factors Preventing Their Clients from Receiving the Services: A Qualitative Study in South Sudan

Objective The study objective was to explore challenges and barriers confronted by maternal and child healthcare providers to deliver adequate quality health services to women during antenatal care visits, facility delivery and post-delivery care. Methods We conducted 18 in-depth-interviews with maternal and child health professionals including midwives/nurses, trained traditional birth attendants (TBAs), gynecologists, and pediatricians in three public health facilities in Juba, South Sudan. We purposively selected these health professionals to obtain insights into service delivery processes. We analyzed the data using thematic analysis. Results Limited support from the heath system, such as poor management and coordination of staff, lack of medical equipment and supplies and lack of utilities such as electricity and water supply were major barriers to provision of health services. In addition, lack of supervision and training opportunity, low salary and absence of other forms of non-financial incentives were major elements of health workers’ de-motivation and low performance. Furthermore, security instability as a result of political and armed conflicts further impact services delivery. Conclusions for Practice This study highlighted the urgent need for improving maternal and child healthcare services such as availability of medical supplies, equipment and utilities. The necessity of equal training opportunities for maternal and child healthcare workers at different levels were also stressed. Assurance of safety of health workers, especially at night, is essential for providing of delivery services.     

The cost and efficiency of public and private health care facilities in Ogun state,Nigeria

During the 1980s, Nigeria faced difficult economic conditions resulting in a severely constrained budget for public health services. To assess more carefully the costs and efficiency of the public and private health sectors, the Federal Ministry of Health in Nigeria undertook a comprehensive survey of health care facilities in Ogun State in 1987, the analysis of which is presented in this study. The findings suggest that there is potential to increase service delivery within existing budgets by more cost-effective allocation of inputs. Many public and private providers are not operating at full technical capacity. It also appears that public facilities are not using cost-minimizing combinations of high and low-level health workers, in particular, too many low-level staff are being used to support high-level workers. The cost analysis indicates that there are short-run increasing returns to scale for inpatient and nearly constant returns to scale for outpatient services. Economies of scope for joint production of inpatient and outpatient services are not being realized. A major implication of such analysis is that improved resource allocation decisions heavily depend on the existence of information systems at the health facility level which carefully integrate financial information with other appropriate and adequate measures of service inputs, health care quality, facility utilization and ultimately health status.     

深圳市社区公共卫生服务包运行的成本结构分析

目的了解深圳市社区公共卫生服务包运行成本的总体情况及财政投入的参考标准。方法在人力成本、基本支持与保障成本测算的基础上,结合社康中心普查资料与统计年鉴,分析服务包运行中各要素成本及其占财政支出的比例。结果完成服务包基本项目时,按每万服务人口计,服务包运行成本为64．67万元,其中人力成本占70％,此时服务包成本占同年财政一般性的比例约为1％。结论深圳市有实力也有必要进一步加大对社区卫生服务的投入,特别是保证人员经费的投入。     

锰作业职工的血中微量元素变化

探讨长期高浓度锰暴露对职工血中微量元素的影响。进一步了解锰作业对工人健康损害的机制,为保护接触锰烟尘作业工人身体健康提供理论依据。方法某局桥梁厂男性电焊工65人作为锰接触组,该厂不接触锰烟尘及其他有害物质的行政、后勤人员65名作为对照组。血锰含量测定采用石墨炉原子吸收法,血中铜、铁、锌、镁、钙含量测定采用火焰原子吸收法。结果锰接触组血中锰含量（0．09．4±0．03μg／m1）高于对照组（0．06±0．05μg／m1）,而钙含量（4．93±2．70μg／m1）低于对照组（5．93±2．65μg／ml）,锌含量没有明显变化。结论长期高浓度锰暴露职工血中微量元素锰含量明显升高,钙含量明显降低,铁含量在接触锰早期明显降低,其他微量元素无规律性变化。     

Ethnic health workers in primary health care

Abstract: Ethnic health workers were employed to increase the access of communities of non-English-speaking background to health services, but their role has remained unclear in a national health system that has been criticised for being slow to respond to the needs of these communities. Interviews and a questionnaire were used to survey a convenience sample of 40 South Australian ethnic health, welfare and community workers and 17 supervisors about the important roles of ethnic health workers, how they should perform their roles and their ability to fulfil them. Interviews with 11 staff from the New South Wales Ethnic Health Worker Program then provided a broader perspective to the South Australian findings. High-priority roles were to provide help to solve immediate health problems. Roles included providing access as well as services. There were pressures on ethnic health workers to become service providers: clients from non-English-speaking backgrounds expected assistance with a wide range of problems, and mainstream staff lacked competence in meeting these needs. Ethnic health workers' involvement in needs assessment and health agency change was limited by these pressures, by ethnic health workers' separation from the work of mainstream staff and because systematic planning of services to non-English-speaking communities was lacking. The appropriate role for an ethnic health worker is as an access provider, with a greater emphasis on needs assessment and agency change. Agencies need to develop culturally appropriate service plans and training so that ethnic health workers and mainstream staff are better able to work together.