医院"在加工材料"贷方累计余额的调整

1998年，国家财政部、卫生部联合制定了《医院会计制度》，对医院制剂室的核算取消了原会计科目中的“制剂收入”与“制剂支出”，将医院制剂室核算归人“在加工材料”科目。“在加工材料”科目核算医院炮制药品、制剂生产、委托加工材料的实际成本。借方核算制剂室领用药品的实际成本及发生的工资、水电费、分摊的管理费等，贷方核     

关于医院开展成本管理与核算的理性思考

无论是营利性医院还是非营利性医院都应积极推行成本核算,这已成0为不争的事实,但就目前全国各地医院开展成本核算的情况来看,发展是极不平衡的,某些状况也是令人堪忧的,我们必须及时澄清对医院成本管理与核算中的模糊认识,解决成本管理与核算的核心问题,才能保证成本管理与核算工作深入持久,卓有成效地开展起来,本文拟就开展成本管理与核算工作急需解决的几个问题进行论述。     

军队医院医疗设备实行单机核算问题的探讨

本文通过介绍我院单机核算的具体做法，就如何加强单机核算管理，改善医疗设备管理水平、提高医院和科室医疗收益进行深入探讨。     

新老《医院会计制度》对制剂生产核算之比较

新的《医院会计制度》（简称“新制度”）对制剂生产核算作了较大的变动，本文试图对新老会计制度中制剂生产核算的异同作一分析和比较。一、会计科目设置不同“老制度”在制剂生产核算中设置了制剂收入、在加工材料、制剂支出、业务收支结余等科目，其中制剂收入科目核算制剂药品入库时按批发价计算的制剂收入；在加工材料科目核算制剂生产过程中领用、消耗和月末结存的药品、材料的成本；制剂支出科目核算为组织和进行制剂生产发生的各项费用以及制剂药品成本；业务收支结余科目核算制剂生产的财务成果。“新制度”则仅仅设置了在加工材料…     

做好军队医院经济管理的地位和作用

医院经济管理是按照医院财物制度或有关规定，核算医院在医疗服务过程中所支出的物质消耗、劳务报酬以及有关费用的收支数额、构成和水平。是对医院服务过程中费用的支配和医疗服务、药品销售、制剂生产等所进行的核算，抓好医院的经济管理，可以促进医院的经济效益和社会效益，推动生产力，使医院内部人力、物力、财力的合理配置和有效利用，充分调动医院各个科室、部门的积极性，提高医院整体管理水平。     

谈医院实物会计标准化管理的应用要求

医院经济标准化管理，对规范医院经济管理行为、协调经济管理秩序具有重要作用。本文从实物会计的核算科目、核算名称、核算代码和核算层次４个方面入手，详细地阐述了实物会计进行标准化管理的应用要求。     

对在加工材料科目中制剂核算的探讨

自1999年起，各公立医院执行国家财政部、卫生部制定的《医院财务制度》、《医院会计制度》，取消了“制剂收入”和“制剂支出”科目，改为“在加工材料”科目，避免了核算上虚增收支的现象…。通过几年来的实践，我们认为在制剂核算方面存在以下问题：(1)生产成果不直观。制剂生产完成入库按售价借记“药品”，按实际成本贷记“在加工材料”，其差额贷记“药品经销差价”，这就是说，制剂的利润是通过“药品进销差价”核算的。而“药品进销差价”包括中成药、中草药、西药和制剂药品，把制剂利润混入其中，如制剂出现报损，将挤占其他药品的差价，给核算带来困难。(2)科目设置简单。“在加工材料”科目核算包括库存物资、低值易耗品和其他材料的委托加工，中药炮制、西药制剂。就西药制剂而言还包括很多内容：人员、公用经费支出，原料、材料、包装用品的购入、领用．包装用品的购入、领用，各项费用支出、亏损或盈利等都在同一科目核算。要在一个科目内说清这么多数据，达到一目了然，相当不易。(3)制剂材料实际库存无法反映。制剂材料有上期库存、本期购人、领用、在生产过程中消耗使用不完的原材料、辅助材料，还有每批生产的成品不一定一次全部调给药库，都要留有一定库存。“在加工材料”科目既要反映库存，更要核算制剂成本和利润，很难在账面上看到制剂的实际库存数。(4)制剂利润核算不明确。制剂有实际成本价，还有物价部门核定的理论成本价，这就出现了一种药品有进销差价还有利润，其差额留在“药品进销差价”造成差价率过高，留在“在加工材料”出现贷方余额，将利润与库存混为一谈，无法确认每月实现多少利润。     

强化军队医院成本核算管理

军队医院成本核算管理日益为总部职能部门所关注。目前,主要问题有成本核算方法不规范;成本核算内容不全面;成本核算软件研发不完善;成本管理职能部门协调不够;成本核算队伍素质不高。今后医院成本核算管理需要完善的重点是药品管理、物资管理、固定资产管理、制剂生产收支管理、间接费用分摊管理和军队医保人员费用管理。医院成本核算绩效评估需要把握的重点是规范核算制度、软件;规范成本核算方法;规范成本效益指标;掌握效益核算公式和形成能效评估体系。强化医院成本核算管理应处理好:财务管理与经济管理的关系;经济管理职能部门与一线科室之间的关系;军内医疗服务核算与对外医院服务核算的关系;事后成本核算与事前预测、事中控制的关系     

计算机在医院制剂核算中的应用

医院药品制剂管理是医院药剂科工作的一个重要组成部分,在医院药学中占有很重要的地位。医院制剂的生产在很大程度上能弥补医院临床用药的不足,并不断开发新的有特点的制剂,它直接影响着医院的社会效益和经济效益。现行的医院制剂手工核算的管理模式远远不能达到科学管理的标准。     

加强药品资金管理的探讨

药品占用资金在医院流动资金中占有很大比例（45％～70％不等），而资金是医院发展的命脉，因此，加强药品进、销、存的动态管理，建立健全科学的管理制度和核算方法，是医院药品管理的当务之急。本文就如何加强药品资金管理进行探讨，以期达到抛砖引玉的目的。     

Cultivating a worldly repose: the contribution of Sally Gadow's work to interpretive inquiry

This paper discusses the contribution that the work of Sally Gadow makes to understandings of interpretive inquiry and it's potential to inform and influence nursing practice, research, and education. The discussion draws on several of Gadow's published works that make explicit her understandings of what it means to be interpretive, to be open to multiple truths, to hear multiple voices, to have a history, to be experienced, and to recognize agency in language. Situating this discussion of Gadow's contribution in opposition to a metaphysics of genius is intended to move our understanding of particular work past the subjectivity that produced it, past the subjectivized responses to the work, past the reporting on myself – my thoughts, my perspectives, my experiences – to explore, to see the worthwhileness or even the possibilities of exploring the work itself and the worlds it evokes. This paper is a deliberate attempt to disrupt the call to the author to save us from the task of interpreting the questions that the work itself places us under. Gadow's work itself points us away from a valorization of the voice of the author of the work, a single voice, and towards a cultivation of a worldly repose where each interpretive account points us to some longstanding whole to which the work belongs and from which it gains its sense and significance.     

On the stability of stigmatization: The case of ex-homosexual males

We undertook to empirically identify variables that influence the stigmatization of ex-homosexuals by analyzing the relationship between stigmatization and seven variables held to influence negative attitudes toward members of other ex-deviant groups: the stimatizer's age, highest achieved educational level, amount of interaction the stigmatizer has had with an ex-homosexual, degree of effectiveness attributed to treatment in changing the homosexual to a heterosexual orientation, degree of responsibility that the stigmatizer attributes to ex-homosexuals for their prior homosexual behavior, degree of dangerousness attributed to ex-homosexuals, and degree of seriousness attributed to homosexuality. Analysis of data obtained by questionnaire from 281 respondents showed that the variable most strongly related to stigmatization of ex-homosexuals was the degree of dangerousness attributed to them. There was a profound direct relationship between these variables. Further, educational level, belief in the effectiveness of treatment, and amount of interaction with ex-homosexuals were inversely related to stigmatization, while degree of seriousness attributed to homosexuality was directly related to stigmatization. Respondents' tendency to stigmatize was not found to be related to age or to their attribution of responsibility to the ex-homosexual for his previous sexual orientation.Paper presented at the 1979 Annual Meeting of the Southern Sociological Society, Atlanta, Georgia.     

Working ‘off the record’: polio eradication and state immunity in Chad

The reappearance of polio in Chad generates anxieties about governance as well as public health. Since Chad was declared polio-free in 2003, at least 180 cases of paralytic polio have been linked to importations of wild poliovirus from Nigeria. In efforts to eradicate polio through house-to-house vaccination campaigns, international agencies have aggressively implicated political leaders, placing those authorities in a bind. On the one hand, governments are required to demonstrate compliance in the form of universal vaccination. On the other hand, the legitimacy of political leaders and of local authorities in particular depends upon their ability to show compassion for their populations and to be responsive to individual circumstances and concerns about the drops. This article looks at how the obligation of the African state to adopt global public health policy as its own becomes problematic when the goals and protocols of international agencies rely on the assumption that the state controls its population. Under pressure to render account to international agencies, state officials deploy high-level politicians to enforce vaccination mandates at critical moments, create administrative forms to record campaign progress that conceal difficulties in vaccinating children, and use statistics to portray the campaigns as success stories. Local authorities, who feel the bind most acutely, grant exceptions to the mandate of universal vaccination to certain subjects and work with local vaccinators and supervisors to keep cases of unvaccinated children ‘off the record’. These efforts allow the vaccination campaigns to be carried out without incident even as they work against the goal of polio eradication.     

Factors related to outcome following a work hardening program

The purpose of this study was to determine factors related to a return to work following the completion of a work hardening program. Data from the Workers' Compensation Board of Alberta Millard Rehabilitation Centre for 1527 discharges, collected over 22 months, were examined retrospectively. Factors related to return to work were compared bivariately using logistic regression procedures. A multiple logistic regression model for return to work was also determined. The principle predictor of return to work was job-attached status to the pre-injury employer. Other factors related to return to work were education, primary diagnosis, injury to admission time, job attachment to the pre-accident employer, employer's annual payroll, and vocational direction. Due to the strength of the association between job-attached status to the pre-injury employer and a return to work, it was concluded that attempts to maintain this relationship should be a priority for rehabilitation providers and insurance carriers.     

综合医院产前诊断系统管理模式及效果评价

产前诊断工作是一个涉及面广的系统工程。为有效地实施产前诊断管理 ,深圳市人民医院建立了完善的管理模式 :经过严格的科学管理 ,本院系统管理对象围产儿死亡率由 1993～ 1995年的 9.0 8‰下降为 1999～ 2 0 0 1年的 1.32‰ ;新生儿死亡率由 1993～ 1995年的 3.77‰下降为 1999～ 2 0 0 1年的 0 .2 6‰ ;出生缺陷率由 1993～ 1995年的7.0 0‰下降为 1999～ 2 0 0 1年的 3.19‰。     

An activity week for children with cancer: who wants to go and why?

Many children now live with cancer rather than die from it, and such children need both to continue their social, emotional and cognitive development and to make long-term psychological adjustments. This paper presents the findings of a research project set up to explore issues pertinent to the current provision of an activity week experience for a group of British paediatric cancer patients. The aims of the study included finding out which factors discriminate between families who apply for a place to attend the week for their child and families who do not, and to develop a knowledge of what factors are considered by parents and children. The findings suggest that the week appeals to children who are confident, active and able to separate from parents and whose parents are keen to encourage independence and new experiences. Children diagnosed and treated at a younger age and further away from treatment were more likely to express concerns about being homesick and safety and to not apply for the week. Issues of protection, independence and disability are discussed with reference to the importance of parental attitude on children's psychological accommodation to disease and treatment and to the experiences of adult survivors of childhood cancer.     

Charging for NHSPlus: an inferential study based on the internal provision of occupational health services within the National Health Service

BACKGROUND: 'NHSPlus' was conceived as a national agency that would provide occupational health services to organizations, for a fee, without imposing any financial burden on the taxpayer. This self-funding requirement brings into focus the resource implications for such a service and the determination of the charges to be made to external clients. AIM: The existing provision of occupational health services to >100000 National Health Service (NHS) staff by 13 NHS occupational health services of various sizes was analysed, with the objective of determining an appropriate charge-out rate to third parties. METHOD: Two focus groups were questioned on their work external to the NHS. Data collected on the allocation of doctors and nurses to occupational health services in relation to the number of NHS clients serviced were used to investigate the nature of the resourcing relationship using regression analysis. RESULTS: The relationship was found to be stable enough to provide a good estimate of staff requirements (the key resource requirement). Combining this with costing information allowed inferences to be drawn concerning the economic cost and hence the break-even rate of charge for the service. This was then compared with the employer charge rates in the NHSPlus published case studies. CONCLUSIONS: The results suggest that the per capita charges to external clients are lower than the per capita cost of internal occupational health provision within the NHS, raising questions about the viability of the service.     

An age-integrated approach to improve measurement of potential spatial accessibility to emergency medical services for urban areas

Objective: This study aimed to develop an age-included approach to measure the potential accessibility to Emergency medical services (EMS) across urban and suburban areas of Mashhad city in Iran. Methods: We used an improved version of two-step floating catchment area (2SFCA) and enhanced 2SFCA (E2SFCA) methods to measure the potential accessibility to EMS services with inclusion of age factor. This enabled us to better model accessibility of the older population to the EMS. We used 22 800 records of EMS enquiries from July to September 2018 to evaluate and assess the potential improvement in access to the EMS with incorporating age in the model. Results: Suburb areas had less potential accessibility compared with central urban due to the high density of EMS stations in the city center areas. Our model showed slight improvement in potential accessibility measurement as a result of the proposed age-integrated method. Conclusion: An age-integrated index of accessibility method takes into account the age distribution of the population in service area is highly associated with actual measures of accessibility to EMS services. Identifying areas with poor access to EMS will help policymakers to design better policy planning to allocate resources and improve provision of EMS services.     

Medical practice and anthropological bias

The purpose of this article is twofold: to describe some of the biases common to anthropological investigations of healing, particularly Biomedical healing; and to suggest that the physician-anthropologist is uniquely positioned to avoid some of these biases and to make valid contributions to the understanding of the practice of healing. Biases described are methodological (the tendency to formal-symbolic analyses rather than practical-instrumental understandings of behavior, transference and the observer effect), ontological (due to the estrangement of the anthropologist from his culture, other disciplines and his subjects, romanticization of the Other and celebration of the exotic over the mundane), and conventional or stylistic (the minimal importance given to emotional or psychological aspects of behavior, the emphasis on visual and linguistic understanding over other forms of investigation, unsophisticated use of medical texts as an indicator of clinical practice, a characteristic mode of reductionism, and the failure to elicit the responses of the subjects to interpretations made by anthropologists). As native-ethnographer, the M.D./Ph.D. physician-anthropologist may avoid some of these biases and offer complementary interpretations of healing.     

Development of an information source for patients and the public about general practice services: an action research study

OBJECTIVE: The publication of information about the performance of health-care providers is regarded as central to promoting greater accountability and empowering patients to exercise choice. The evidence suggests that the public is not very interested in accessing or using current sources of information. This study aimed to explore the information needs of patients in the context of UK primary care and to develop an information source about general practice services, designed to be usable by and useful to patients. DESIGN: An action research study making use of data from formal and informal interviews, focus groups, participant observation and document review. SETTING: The geographical areas covered by two Primary Care Trusts in the north of England and two Local Health Boards in south Wales. PARTICIPANTS: A partnership between 103 members of the public, general practice staff from 19 practices, NHS managers from four Primary Care Organizations and the research team. RESULTS: The public would like to know more about the quality and range of general practice services but current sources of information do not meet their needs. The public do not like league tables comparing the performance of practices and only a small number of people want to use comparative information to choose between practices. They seem to be more interested in the context and availability of services and the willingness of practices to improve, than in the practice's absolute or relative performance. They want to be clear about the source of the information so that they can make personal judgements about its veracity. Information is most likely to be useful if it adheres to the basic principles of cognitive science in terms of its structure, content and presentation format. Using these findings, paper and electronic prototype versions of a guide to general practice services have been developed. CONCLUSIONS: In order to maximize the potential use of performance information by the public it is necessary to move beyond provider-led and professionally constructed approaches to information provision and ensure that the public is actively involved in the development of information sources. Such involvement produces a different kind of information to that currently available to the public. The findings of this study have important implications for policy. Most importantly, it seems that the traditional consumerist model underlying a policy of making comparative performance information available to the public to enable them to exercise choice between primary care providers may not be appropriate. An alternative model of information provision, which recognizes the public's commitment to their practice and is integrated with 'soft' sources of knowledge is more likely to engage and be of use to the public.