对医药分开与取消药品加成政策的思考

《中共中央国务院关于深化医药卫生体制改革的意见》提出．推进医药分开,积极探索多种有效方式,逐步改革以药补医机制。通过实行药品购销差别加价、设立药事服务类等多种方式逐步改革或取消药品加成政策。本文仅就医药公开、取消药品加成政策的预想效果,对医疗机构的影响和补偿办法等有关问题提出一些看法。     

放在公立医院改革整体中对待

<正>公立医院药房改革的目的是破除以药补医。这里的以药补医有两层含义:一方面是指以药品加成收入补助医院医疗收入亏损;另一方面是以药品回扣方式暗中补偿医师收入。对应的,破除以药补医也有两层含义。第一,公立医院的药品加成收入是医疗机构收入的主要来源,改革目标就是要取消占比达40%以上的药品加成收入,改革手段有提高财政补助投入、提高诊疗收入。第二,切断医药利益联系,即阻断医师开大处方以获取回扣的利益驱动,     

医药分开是公立医院改革的攻坚战

破除以药补医机制能够取消药品加成,但无法根除处方回扣。不能把破除以药补医机制等同于医药分开改革,更不能用破除以药补医机制取代医药分开改革。     

湖北省县级公立医院推进药品零加成改革的效果分析

根据国务院《"十二五"期间深化医药卫生体制改革规划暨实施方案》,在"十二五"期间要理顺补偿机制,全面取消"以药补医".湖北省28家试点医院于2012年9月开始取消药品加成政策,实行药品零差率销售.本研究通过调查28家试点医院改革现状,对改革前药品收入占业务收入的比例、改革后医疗费用控制、医院服务量、患者满意度、医务人员收入、政府投入等进行描述性分析并提出完善和深入推进医药分开政策的建议.     

青海省2009年将开展医疗机构药品零加成试点

青海省2009年将在省内开展医疗机构药品零加成试点,切实改革医疗机构以药补医机制。     

利用指数因素分析法对某公立医院综合改革前后业务收入的分析

<正>医院药品收入和医疗收入是医院业务收入主要组成部分,药品收入和医疗收入比例的变化,不但影响医院经济运行状况,更能反映医院医疗资源的合理利用程度。2012年国务院办公厅以国办发33号文《关于县级公立医院综合改革试点意见》提出:改革"以药补医"机制,鼓励探索医药分开的多种形式。取消药品加成政策,将试点县级医院补偿由服务收费、药品加成收入和政府补助三个渠道改为服务收费和政府补助两个渠道。医院由此减少的合理收入,通过调整医疗技     

北京医改究竟带来哪些改变:医患直接冲突利益点卸掉

正北京医改方案于22日正式发布。根据方案,北京所有公立医疗机构将于4月8日起全面取消药品加成,统一实施药品阳光采购,设立医事服务费。有报道称,北京医改迈出关键一步。这也意味着在北京看病即将开启"医药分开"的时代。长期以来,以药补医机制是公立医疗机构重要的补偿渠道和收入来源。以药补医机制虽然曾经发挥过积极作用,但弊端越来越明显。自2009年,新一轮医改启动以来,"看病难""看病贵"问题在一定程度上得到缓解,但"以药     

药品零差率政策对陕西省县级医疗机构收支影响研究

目的:对陕西省不同地区县级公立医疗机构取消药品加成后的影响进行分析,对医疗服务价格变动补偿进行预测,为县级公立医疗机构实行基本药物“零差率”销售政策提供参考依据.方法:通过计算医疗机构的药品加成收入,运用敏感性分析的方法对医疗机构取消药品加成后的收支结余进行分析,同时从提高医疗服务价格的补偿角度进行了预测.结果:基本药物加成收入取消后对医疗机构总收入影响不大,同时如果财政补助不变,依靠调整医疗服务价格的办法保证现有收入调整的幅度也不大.结论:基本药物“零差率”政策的实施对不同地区的影响不同,在对医疗机构进行补偿时可以借机改变医疗服务价格的不合理的现状.     

对卫生部项目成本测算方法（试点）的探讨

新“医改”政策的正式出台引起了全国上下的高度关注,在具体实施细则尚未公布的情况下,有一点是可以肯定的：从根本上扭转目前医疗机构靠药品加成收入来“以药补医”的补偿机制,准备通过设立药事服务费,适当调整部分医疗服务价格、增加财政投入和改革社会医疗保险支付方式等多种措施,使医疗服务成本能够得到合理补偿。     

"以药补医"机制的现象分析及可控策略

为探讨有关“以药补医”机制的改革策略，对山东省城市综合性医院的“以药补医”状况进行了综合分析，结果发现：1999～2003年间，山东省城市综合性医院中，医院对药品收入一直有着较大的依赖性；药品结余率和医疗亏损率总体上均呈上升趋势，这揭示必须尽快解决医疗亏损、“以药补医”问题．为此，对“以药补医”机制的“合理”与“不合理”及有关的解决策略进行了深入讨论，并提出了相应的建议、     

Further Application of the Care Transitions Intervention: Results of a Randomized Controlled Trial Conducted in a Fee-For-Service Setting

The study objective was to test whether a self-care model for transitional care that has been demonstrated to improve outcomes in Medicare Advantage populations—The Care Transitions Intervention—could also improve outcomes in a Medicare fee-for-service population. Intervention patients were less likely to be readmitted to a hospital in general and for the same condition that prompted their index hospitalization at 30, 90, and 180 days versus control patients. Coaching chronically ill older patients and their caregivers to ensure that their needs are met during care transitions may reduce the rate of subsequent rehospitalization in a Medicare fee-for-service population.     

Concern About Past Trauma Among Nursing Home Admissions: Report From Screening 722 Admissions

ObjectiveMajor life changes can trigger a traumatic stress response in older adults causing trauma symptoms to resurface. In 2019, the Centers for Medicare and Medicaid Services released the requirement, without specific guidance, for trauma-informed care (TIC) as part of person-centered care in long-term care.DesignObservational, cross-sectional.Setting and ParticipantsA total of 722 new admissions at one nursing home in metro Atlanta between November 2019 and July 2021.MethodsWe developed a “TRAUMA” framework for TIC screening based on Substance Abuse and Mental Health Services Administration resources. The admissions nurse conducted TIC screening within 48 hours of new admissions, including reported trauma and necessary modifications to care plans. Demographic information was derived from electronic records. Analysis included independent sample t-tests, binary logistic regression, and χ² tests. All data were analyzed using SPSS v. 28.ResultsOf 722 new admissions, 45 (6.2%) indicated experiencing trauma. There was no significant association with being Black or non-White and experiencing trauma, but there was a significant association with being female and experiencing trauma (χ² (1) = 5.206, P = .022). Only men reported child physical abuse and war trauma and only women reported adult sexual assault, child sexual assault, adult domestic violence, school or community violence, adult nonintimate partner violence, and other trauma. There was a small, significant negative association of age and trauma (β = ?0.037; SE = 0.11; P < .001). The most-reported trauma category was medical trauma, including COVID-related trauma. More than half (51%) requested spiritual intervention and only 2 requested medical intervention with medication as initial interventions.Conclusions and ImplicationsOur experience suggests that knowing the patient and their trauma history allowed the admissions nurse and interdisciplinary care team to modify the person-centered care plan to best meet the patient's needs. Our results also emphasize the need for using universal trauma precautions in all interactions.     

The costs of care: An ethnography of care work in residential homes for older people

The cost of social care, the work conditions experienced by care workers and the quality of care provided by residential homes for older people are all linked, yet we know very little about how this relationship works in practice. Drawing upon an ethnography of two differently priced residential care homes for older people in Southern England, I examine the implications of different financial regimes for care-giving practices. I show how the scheduling and allocation of resources—conveyed, for example, in formal routines and staffing levels—structure the care workers’ time, tasks and activities in each setting. This acts to symbolically demarcate what, or who, is valued. I argue that the availability of resources facilitates and impedes the symbolic culture of care work, shapes care workers’ ability to afford dignity to the individuals in their care and affects how care workers experience, and relate to, their labour. I conclude by discussing how current practices of funding and pricing social care have effects seeping beyond the practical and measurable, and into the realm of the symbolic.     

Multiple Funding Sources

No abstract available for this article.     

The care receivers perspective: How care‐dependent people struggle with accepting help from family members,friends and neighbours

In many countries in north‐western Europe, the welfare state is changing, and governments expect a great deal of informal care. In the Netherlands, citizens are also increasingly expected to rely on informal instead of professional care. In this study, we aim to determine to what extent Dutch care‐dependent people want to rely on social network members and what reasons they raise for accepting or refusing informal care. To answer this question, we observed 65 so‐called ‘kitchen table talks’, in which social workers assess citizens’ care needs and examine to what extent relatives, friends and/or neighbours can provide help and care. We also interviewed 50 professionals and 30 people in need of care. Our findings show that a great deal of informal care is already given (in 46 out of 65 cases), especially between people who have a close emotional bond. For this reason, people in need of care often find it difficult to ask their family members, friends or neighbours for extra assistance. People are afraid to overburden their family members, friends or neighbours. Another reason people in need of care raise against informal care is that they feel ashamed of becoming dependent. Although the government wants to change the meaning of autonomy by emphasising that people are autonomous when they rely on social network members, people who grew up in the heyday of the welfare state feel embarrassed and ashamed when they are not able to reciprocate. Our findings imply that policymakers and social professionals need to reconsider the idea that resources of informal care are inexhaustible and that citizens can look after each other much more than they already do. It is important that social policymakers approach the codes and norms underlying social relations more cautiously because pressure on these relations can have negative effects.     

Long-Term Care Insurance in China: Public or Private?

China faces an overwhelming and urgent need for long-term care (LTC). We explored long-term care insurance (LTCI) plans in China and the factors associated with each plan’s contribution rate. A cross-sectional survey of 814 residents (18–59 years) was conducted to assess the expectations of elderly care, public and private LTCI features. Public LTCI may be more popular whether in terms of participation or contribution. The factors associated with public LTCI contribution rate were healthcare costs, household income, and number of daughters; for private LTCI, the factors were the proportion of living expenditures, worry about future care problems, and healthcare costs. Policymakers should develop public LTCI as a solid foundation and improve private LTCI as a substitute to meet the urgent LTC needs in China.     

The quality and adequacy of care received at home in the last 3 months of life by people who died following a stroke: a retrospective survey of surviving family and friends using the Views of Informal Carers Evaluation of Services questionnaire

Stroke is the third leading cause of death in the UK. Despite this, little is known about the care needs of people who die from or following a stroke. In early 2003, a total of 183 questionnaires were returned from a survey of 493 people who had registered a stroke-related death in four Primary Care Trusts, giving a response rate of 37%. This paper reports on 53 deceased from the survey who had lived at home during their last 3 months and who had been ill for more than 1 month. The data were analysed to explore the role of informal carers and the provision of community-based care in the last 3 months of life. Family and friends helped 82% of deceased with household tasks, 68% with personal care, 66% with taking medication and 54% with night-time care. By contrast, health and social services helped 30% with household tasks, 54% with personal care, 20% with taking medication and 6% with night-time care. Two-fifths (43%) of informants had to give up work or make major life changes to care for the deceased, and 26% of informants found looking after them 'rewarding'. Half (51%) reported that help and support from health services were excellent or good compared to 38% for social services. Results from the Regional Study of Care for the Dying indicated that people who died from a stroke in 1990 and their informal carers would have benefited from increased levels of community-based care and enhanced communication with care professionals. Our data suggest that informal carers continue to provide the majority of care for those who die from stroke, despite government initiatives to improve care for stroke patients and frail elderly people. Further research is required to explore best practice and service provision in caring for this group.     

Retention of Clients in Service Under Two Models of Home Health Care for HIV/AIDS

ABSTRACT

Objective: To determine if a Transprofessional, care-management approach (experimental group) produces different patterns of retention in home treatment as compared to a Traditional treatment approach (control group). The care-management approach utilizes an interdisciplinary mix of allied health professionals who adhere to a service delivery protocol based on active medical, surgical treatment (curative services) as well as on pain, symptoms, and emotional care (palliative services). Initially, the Transprofessional Model should lead to a greater retention rate in the program as patients bond to blended care managers, but in later stages clients needing hospice should be moved off-services resulting in lower retention rates in the medical-surgical home care venue.

Data Sources and Study Setting: Data were collected from 549 AIDS patients admitted for medical/surgical home-care services to the Visiting Nurse Association of Los Angeles (VNA-LA). Demographic and disease-specific data were collected from admitting records; service-utilization data were collected from the VNA-LA's computerized data system.

Study Design: Upon admission for home-care services, patients were randomly assigned to an experimental (Transprofessional) or control (Traditional) treatment group. Service levels were comparable.

Primary Finding: In the earliest stages, Transprofessional patients tend to be more likely to stay in treatment, probably due to the greater bonding to the program. After about one year, the Transprofessional patients are more likely to leave the program as they are transitioned into hospice care.

Conclusions: An integrated model of service delivery, which is based on interdisciplinary care-management and blended modalities of service, provides a quality of life enhancing and a cost-effective method in the provision of home-care services for terminally ill AIDS patients.     

Quantifying posthospital care transitions in older patients

BACKGROUND: Older patients frequently receive care in multiple settings. However, there has been a paucity of studies that quantify the number of care transitions or that attempt to explain utilization patterns over a given time period. Furthermore, no studies have examined transitions based on method of payment. OBJECTIVE: The objective of this study was to examine the number of different posthospital interinstitutional transfers (including hospital, inpatient rehabilitation facilities [IRF], and skilled nursing facilities [SNF]) by method of payment (managed Care [MC] or fee-for-service [FFS]). DESIGN: Prospective cohort followed for 12 months. Method: A total of 1055 older patients were identified on transfer from an acute hospital to either an SNF or IRF. Utilization and mortality was tracked over 12 months through analysis of administrative data, chart review, nursing assessments, and patient interviews. RESULTS: After 3 months, 65.3% of MC patients and 75.6% of FFS patients experienced between two and three transfers and an additional 13.8% of MC patients and 14.6% of FFS patients experienced between four and six transfers. Over the next 9 months, the frequency of patient transfers uniformly declined in both payment groups. CONCLUSION: This study demonstrates that interinstitutional transfers are common in older patients. The majority of these transfers occurred within the first 3 months after hospital discharge for both payment groups. Understanding the frequency and patterns of posthospital care transitions is an important step toward designing innovative approaches to improve the quality of care transitions and ensuring patient safety across settings.