完善医疗服务价格项目规范医疗机构收费行为

由国家卫生部、国家中医药管理局和国家发改委联合颁发的《全国医疗服务价格项目规范(试行)》(以下简称《规范》),在全国贯彻实施已经5年了,目前全国绝大多数省、     

关于 2001 年版与 2012 年版《全国医疗服务价格项目规范》对接的思考

方便各地对新旧两版《全国医疗服务价格项目规范》所列医疗服务价格项目顺利对接,全国医疗服务价格项目规范课题组向各省、自治区、直辖市物价和卫生主管部门提供了“新旧规范医疗服务价格项目对接表”.本文介绍了两版《全国医疗服务价格项目规范》的分类、章节、框架的区别及对接的原则,结合目前各省、自治区、直辖市的主要作法,建议各地在开展对接工作时要加强培训、深入理解和熟悉其内容,以便正确使用,并在对接工作中疏理定价成本相关要素,为合理定价奠定基础.     

《全国医疗服务价格项目规范》中手术项目合理定价机制的探讨

以临床手术治疗项目为研究对象,对2001年版及2007年版《全国医疗服务项目价格规范》修订过程中遇到的问题进行思考,从2012年版《全国医疗服务价格项目规范》的框架构成因素和设计理念来分析论述,探讨如何建立更加科学合理的手术项目定价机制.     

医疗服务价格信息化管理探讨

通过分析总结近年来我国医疗服务价格信息化管理建设中的经验与教训,提出对医疗服务价格信息化建设的思路和框架,并对下一步医疗服务价格信息化管理工作建设提出具体建议.     

深圳实施新版医疗服务价格后政府对非营利医疗机构管理的思考

深圳市在执行新版医疗服务价格后,由于价格制定、政府的补贴等方面存在的问题,使得非营利医疗机构经营面临困难.文章着重就制定医疗服务价格的方法、核算非营利医疗机构的经营成本,加大政府投入以及建立社会捐赠机制提出了思考,希冀得以促进非营利医疗机构健康有序的发展.     

2012年版《全国医疗服务价格项目规范》修订原则及思路

通过介绍2012年版《全国医疗服务价格项目规范》修订原则和思路,期盼能够对有关部门和医疗机构加深对2012年版《全国医疗服务价格项目规范》的理解有所帮助.     

我国医疗服务价格项目技术难度和风险程度赋值的设计与应用

2012年版《全国医疗服务价格项目规范》于2012年5月4日由国家发展和改革委员会、卫生部和国家中医药管理局在2001年版和2007年版的基础上修订后联合颁布实施,本次修订过程中首次对基于医院资源消耗相对值的赋值进行研究和设计,将服务项目所需消耗的基本人力消耗和耗时、项目的技术、风险等体现医务人员技术劳务部分的要素作为定价因素在规范中发布,文章重点介绍了“技术难度”和“风险程度”赋值的设计及应用.     

《全国医疗服务价格项目规范》中临床诊疗服务项目修定原则

通过对《<全国医疗服务价格项目规范>(试行)2001年版》及《<全国医疗服务价格项目规范>(新增和修订项目)2007年版》中临床诊疗服务修订内容的研究,从框架、栏目、内容以及计费方式等方面对修订的情况进行分析阐述,对临床诊疗服务的修订原则进行总结,为医疗服务项目的合理定价提供参考.     

关于医疗服务分等级定价原则的思考

各地对医疗服务价格进行调整后,不同等级的医疗机构实行分等级定价.在核定各级医疗机构的医疗服务价格时,必须考虑医疗服务成本、财政补助收入和药品加成收入三方面因素对医疗服务价格的影响。     

中药调配的特殊性及中药调配服务价格项目实施要点

通过分析中药调配的目的和意义,进一步阐述《全国医疗服务价格项目规范》设立中药调配服务价格项目的必要性,并总结中药调配项目实施中应注意的问题及项目实施要点.     

Violence against doctors: a medical(ised) problem? The case of National Health Service general practitioners

Violence against doctors provides an illuminating context for studying medicalisation and its limits in the management of deviance. The paper examines the emergence of such violence as a policy issue in England, with particular reference to general practitioners (GPs) in the National Health Service. Recent guidance exhorts doctors to exercise ‘zero tolerance’ with respect to acts of violence. The emphasis is on risk management and protecting victims rather than on resolving the perpetrators’ problems. The paper argues that this policy frame is consistent with recent claims from criminologists that there is a new ‘turn’ in penal policy, away from rehabilitation and addressing the needs of individual offenders. However, responses of individual GPs, obtained through a postal questionnaire sent to c.1000 GPs and in‐depth interviews with a sub‐sample, suggest that doctors are not ‘zero tolerant’ in responding to attacks. But nor are they medical imperialists seeking to include all perpetrators within their professional jurisdiction. Rather, they exercise professional discretion about behaviours which often fall into a ‘grey area’ between ‘illness’ and ‘crime’, and about individuals who are not clearly categorisable as either ‘sick’or‘bad’.     

The snakes and ladders of National Health Service management in England

This article explores managerial careers in the National Health Service (NHS) through the lens of talent management, particularly focusing on how managers view barriers (snakes) and facilitators (ladders) to career progression. There is a significant literature on enablers and barriers to career progression, but much of this focuses on specific groups such as black and minority ethnic and female workers, and there is relatively little material on the general workforce of the NHS. The research design is a mixed method quantitative (questionnaire) and qualitative (interview and focus group) approach consisting of a quasi‐probability element that focuses on a maximum variety sample and a purposive element that seeks policy views at central and strategic health authority level, and examines talent management in high‐performing NHS organisations. Ladders are identified as follows: volunteering, secondment, networking, mentoring, academic qualifications, development, good role models/managers and appraisal/personal development plan. Snakes are identified as managing expectations; identity and cognitive diversity; location; sector; NHS toxic and favouritism culture; poor talent spotting; credentialism; exclusive approach to talent; and sustainability. It concludes that while previous conceptual and empirical work is fairly clear on any ladders, it is less clear on snakes. Copyright © 2013 John Wiley & Sons, Ltd.     

From competition to co-operation: new economic relationships in the National Health Service

The Labour government has outlined its plans to ‘replace’ the competitive internal market with a more collaborative system based on partnership. Agreement amongst purchasers and providers is to be based on co-operation rather than competition. Longer term agreements covering periods of 3–5 years are to replace annual contracts within this new environment. The aim of this paper is to explore the potential economic implications of these policy changes by drawing on the economics of co-operation and the transaction costs approach to longer term contracting. Issues surrounding the role of trust in contractual relationships are explored and the relevance of experience and evidence from non-health care sectors is considered in the context of the NHS. It is concluded that both theory and empirical evidence suggest that co-operation and trust can play a central role in the efficient organisation of contractual arrangements in circumstances similar to those under which the NHS operates. However, we warn against the expectation that the policy changes will produce automatically the scale of benefits predicted by the Labour government, especially as they will have to find a way of extracting reasonable performance from providers under a system of collaboration and long term agreements. They may find they need to tread a fine line between competition and co-operation in order to reap the benefits of both. © 1998 John Wiley & Sons, Ltd.     

The Americanization of the British National Health Service: A typological approach

There have been many different claims that the British National Health Service (NHS) is becoming ‘Americanized’. Focusing on the United Kingdom, this article critically analyses the “Americanization” of the NHS in three main sections. First, we explore the basic meanings of the term. Second, we examine the development of the discourse about Americanization. Third, we focus on one of many possible meanings of Americanization, namely system change. Focusing on this most demanding dimension of Americanization, we suggest that most changes have been ‘internal changes of levels’ (where there is a shift of levels in one or more dimensions but without changing the dominant form) or ‘internal system changes’ (where only one dimension changes its dominant form) rather than a ‘system change’ (from one ideal type to another).     

National Health Insurance Scheme: An Assessment of Service Quality and Clients' Dissatisfaction

BackgroundHealth Insurance Scheme (NHIS), a medical package to start with a fraction of Nigerians at its inception, with the expectation of optimal services to all in the long The Nigerian government established National run. However, there are complaints and dissatisfaction of enrolees of the scheme. This study determined factors responsible for enrolees'' dissatisfaction of services in a general hospital within the federal capital territory, Abuja.MethodThree hundred enrolees of National Health Insurance Scheme at the Kubwa general hospital were enrolled. Semi structured questionnaires were used to obtain information on socio-demography, education, enrolee status, perception of the scheme and factors responsible for enrolees'' dissatisfaction. SPSS version 22 was used to analyse Data using percentage.ResultsMajority (66.3%) of the respondents were between 35 and 54 years while 28.5% were below 35years and 11.8% (32) were above 54years with the male to female ratio was 1.03:1. Sixty percent (179) of the respondents had a minimum of tertiary education with just 1.8% having primary education. Most (69.9% and 79.6%) respondents were principal enrolees and public servants respectively. Seventy percent of the respondents have been enrolled in NHIS for more than 3years and had a good perspective of the scheme. However, 30% of the respondents were not satisfied with NHIS services with 8.6% and 15.4% describing the services as substandard and below expectations respectively. Half (50.7%) of the respondents would consider an alternative to NHIS suggesting their dissatisfaction. The major factors responsible for dissatisfaction were billing system, long waiting hours and staff attitude accounting for 46.9%, 59.4% and 7.8% respectively.ConclusionThis study revealed that the level of clients'' dissatisfaction with NHIS services is high despite their acceptance of the scheme with the major areas of concern being the billing system, waiting time and staff attitude. Therefore, it is necessary for the providers to look more into these areas as targets for service delivery improvement.     

Universal Health Coverage in Italy: lights and shades of the Italian National Health Service which celebrated its 40th anniversary

The Italian National Health Service (I-NHS) was established in 1978 to guarantee universal access to healthcare. Prominent in international reports, the I-NHS has reached a satisfactory level of efficiency and excellent standards of care in many regions, in forty years. Along the years, I-NHS has developed a structural public-private partnership in health services delivery that in some regions contributes to the achievement of very high standards of healthcare quality. However, the I-NHS is currently facing some major challenges: (a) Italy is experiencing a remarkable aging of its population with increasing health needs; (b) the recent and constant cuts to public expenditures are reducing the budget for welfare. It is of utmost importance to ensure that on-going efforts to contain health system costs do not subsume health care quality. In addition, monitoring of the essential levels of care (Livelli Essenziali di Assistenza, LEA) highlights significant differences in healthcare delivery among Italian regions that, in turns, contribute to the burdensome migration of patients to best-performing regions. Therefore, a more consolidated and ambitious approach to quality monitoring and healthcare improvement at a system level is needed to guarantee its sustainability in the future.     

英国国民卫生服务制度(NHS)的结构性改革与治理模式

基于英国NHS在管理体制与机制上所实施的结构性改革措施,从完善法律、建立问责机制、完善财务管理和经营模式4个维度,系统阐述了NHS的结构性改革与治理模式的特点;作为一种"公共利益公司",NHS所属公立医院基于公私伙伴关系的原则,在坚持公益性的前提下,引入企业经营行为组建了信托基金医疗联合体,并根据NHS的核心原则,免费医疗、需求导向、可负担性等,基于购买合同向辖区患者或居民提供医疗保健服务。随着相关改革措施的逐步实施,NHS信托基金医疗联合体的法人地位和自主决策权得到明显提升,能真正做到对自身的发展负责;同时,随着对提供者行为的规范,以及医疗服务市场竞争与规制机制的完善,也极大的促进了医疗机构之间的有序竞争和医疗服务供给的多元化发展。     

浅谈医疗服务价格调整的机遇与挑战

通过分析医疗服务价格政策调整变迁的历史原因、制定过程、目前医疗服务价格及价格管理存在的主要问题,提出《全国医疗服务价格项目规范（2012版）》给价格调整带来的机遇与挑战。