“互联网+医疗”如何实现医疗数据采集最大化

正国务院办公厅日前发布的《关于促进"互联网+医疗健康"发展的意见》,鼓励医疗机构应用互联网等信息技术拓展医疗服务空间和内容,构建覆盖诊前、诊中、诊后的线上线下一体化医疗服务模式,加快实现医疗资源上下贯通、信息互通共享、业务高效协同。同时,明确允许依托医疗机构发展互联网医院,支持探索医疗机构处方与药品零售信息共享,探索放开院外处方和第三方配送,打通在线问诊、处方、     

论第三方管理医疗保险

第三方管理医疗保险的目的是为投保人提供及时周到的医疗服务，同时提高保险机构的效率和效益．并在控制医疗成本和确保医疗服务质量方面发挥作用。第三方管理医疗保险在我国还处于探索阶段，是当前我国医疗保险市场研究和开拓的重要领域。     

健康管理对医疗服务市场的管制作用

本文分析医疗服务市场的特点，指出该市场中竞争的不完全性和市场失灵；从第三方角度进行的健康管理能有效弥补医疗信息不对称，促进医疗服务市场竞争，弱化市场失灵的影响，从而发挥市场管制作用；当前推行健康管理要把握医疗机构和第三方管理机构或组织作为不同主体提供的服务的差异性，提倡引进竞争性的、市场化的健康管理运作模式。     

中国医疗服务治理机制的目标范式

保障公民健康是政府的责任。政府提供医疗卫生公共品的效率与政府的能力相关,而优化医疗服务治理机制可以支撑和强化政府能力。现代医疗服务管理和治理应当注重对医疗服务信息的控制,即动态外置（释放）诊疗信息和财务信息。医疗服务管理经历了医生自律主导、医院管理主导、第三方付费制约主导等3个发展时期,正在进入第4个发展时期——社会评价与监督主导时期。一个从医生自律、医院管理、第三方付费制约到社会评价与监督的治理结构正在形成,即“二维四圈型医疗服务机制”。社会化管理式医疗是中国医疗服务治理机制的目标范式。     

社区卫生服务机构发生医疗纠纷的原因与对策

社区卫生服务机构是社区卫生服务工作的主要载体,主要由社区卫生服务中心和服务站组成,目前存在着医疗设备落后、人才欠缺、技术水平较低、非技术性服务不到位等实际问题,加上来自医方、患方及社会的各种原因,较容易发生医疗纠纷。防范的关键在于不断提高医务人员的业务素质、规范内部管理、购买医疗责任保险、建立健全医患纠纷第三方调解机制等。     

美国医疗卫生政策和管理的特征

美国医疗卫生政策和管理的特征李小言一、美国医疗卫生服务的特征１．商品化：在美国，医疗卫生事业已不再被认为是纯福利性事业，而是一种商业产品。要想享有医疗服务就必须去购买，途径是通过保险公司，在美国称为第三方。２．保险与第三方付款：美国医疗服务有下列复杂...     

2019年福建省疫苗配送成本调查

目的 分析福建省疫苗配送成本。方法 选取1个省级、9个市级、18个县级疾病预防控制中心(Center for disease control and prevention, CDC)收集2019年免疫规划(Expanded Program on Immunization, EPI)疫苗/非EPI疫苗从省级CDC至接种单位各环节的配送成本；选取2家第三方冷链物流企业收集非EPI疫苗从企业至县级CDC的配送成本，计算各环节平均配送成本。结果 2019年福建省EPI疫苗从省级CDC至市级CDC、市级CDC至县级CDC的平均配送成本分别为0.14元/剂、2.47元/剂；EPI疫苗和非EPI疫苗从县级CDC至接种单位的平均配送成本为4.99元/剂；非EPI疫苗从第三方物流企业至县级CDC的平均配送成本为2.58元/剂。结论 区域集中仓储、统一配送可使疫苗配送成本下降、效率更高。     

医疗服务模式的理论界定及实践类型

医疗服务模式是指医疗服务提供者、医疗服务接受者和医疗服务管理者三方之间的制度化互动关系，医疗服务模式的核心内涵是影响医疗服务质量、价格和服务方式的权力关系。依据权力关系，医疗服务模式可以区分为两种基本类型：都以医疗服务管理者为核心的医疗服务模式和以医疗服务提供者为核心的医疗服务模式。     

第三方满意度评价与自我评价在改善医疗服务中的应用

通过考察省级卫生计生委监督下的项目,分析第三方满意度调查及医院自我评价方式对改善医疗服务效果的影响。通过第三方评价及某三甲医院"5心"服务式自我评价结果的运用细化就诊流程环节、责任到人等方式,改进医疗服务的薄弱环节、提升医院服务,提高第三方满意度。     

四川省人民医院健康体检中心

四川省医学科学院、四川省人民医院健康体检、健康管理中心是四川省大型医疗机构第一个从事专业健康体检、健康管理的大型医疗服务中心，具有鲜明的特色和技术服务优势。     

基层卫生服务整合模式的探索——以广州市南沙区为例

发展整合卫生服务已成为我国医改的战略性选择,广州市南沙区以整合卫生服务理论为指导,以“人人享有基本医疗”为目标进行了一系列改革,包括管理体制的改革、镇（街）村两级卫生机构的整合、人力资源的整合、信息的整合、村卫生室的标准化建设和各项卫生政策的组合运用,改善了卫生服务的公平性、可及性,提高了基层卫生资源的利用效率,充分体现了基层卫生服务的公益性属性。在构建农村基层卫生服务整合模式方面做了有益的探索,该经验可以进一步推广。     

基层卫生机构服务供给质量差距分析

基层卫生机构是我国医疗卫生服务体系的网底,合理评价基层卫生机构服务供给质量对提升基层卫生机构服务质量至关重要。本文借鉴服务质量差距模型,从居民和基层卫生机构两个视角,分析基层卫生机构在认知、服务质量标准、服务传递、服务绩效及服务质量五个层面的差距,并为基层卫生机构提高服务质量提出合理政策建议。     

加拿大健康服务整合:实践与启示

系统梳理了近年来有关加拿大卫生服务整合的文献和政策文件,归纳了安大略省、阿尔伯塔省和魁北克省的卫生服务整合实践及方式,包括卫生组织机构间整合、卫生服务团队整合以及一系列卫生服务整合,并总结组织机构间整合的促成因素和阻碍因素以及具体的整合策略。结合中国实际,提出我国在推进卫生服务整合过程中应坚持以政府为主导,充分发挥市场机制的积极作用,通过基层卫生服务的网络式管理与组团式服务,将重点人群和特定疾病的卫生服务整合视为战略重点,发挥护士在卫生服务整合中的助推作用,建设有利于整合的卫生信息系统,不断推进分级诊疗并弥合割裂的卫生服务体系,为居民提供个性化、方便、综合、连续的整合型卫生服务。     

When health technologies do not reach their effectiveness potential: a health service research perspective

This paper tries to unravel the following question: why do we sometimes obtain results that are worse than expected despite having used technologies that are provenly efficacious or effective and having eliminated major groups of causes leading to poor performance? Inductive analysis and synthesis based on nine areas of health service research show that to effectively adopt some health technologies, it is not enough to simply choose an efficacious or effective change strategy. It sometimes becomes necessary to change the behavior of the health workers that will use it, and to modify certain environmental elements. Technology's effectiveness also depends on intervening simultaneously at various levels. Using a mix of evidence-based change (multifaceted) strategies is often mandatory. Improving health service calls for permanent, not sporadic, efforts; for ensuring universal access to information, and for adopting regulations to prevent poor or potentially harmful service delivery. A portion of the service improvements that have been attained have resulted from the use not of isolated change measures, but of combinations of the most effective measures as part of a single integrated intervention. To further reduce the gap between observed and expected effectiveness we should pilot behavior change strategies before adopting some health technologies, and to permanently install in our health system the multifactorial, integrated technology adoption mechanisms that we still lack. Failure to do this will mean being inefficient and pursuing short-term results at the expense of feasible and legitimate medium-term objectives.     

邮政分发调查法在评价社区卫生服务机构满意度中的运用

目的为了客观评价社区卫生服务效果,减少主观因素的干扰,利用邮政分发系统作为第三方对社区卫生服务机构进行群众满意度的评价。结果第三方评价真实的反映了武汉市社区卫生服务机构的现状,居民对社区卫生服务的满意度达到83%以上。结论利用邮政分发来对现有的社区卫生服务机构进行第三方的评价,客观、快捷,而且可行、可信。     

农村三级卫生服务网络的服务连续性探讨

分析了农村卫生服务提供系统存在的问题以及导致农村三级医疗卫生服务网络异常运行的根源,从学科间的连续、机构层面的连续、人际层面的连续及信息层面的连续4个方面,提出重塑农村三级医疗卫生服务网络中各机构关联、构建合理的网络机构管理所需的适宜支撑环境以及提供系统的安全、有效、方便及价廉的质量观等政策建议.

Abstract：

Through the analysis of the problems of health service delivery system in rural areas and the causes of the abnormal operation of the three-tier rural health service network, this article probed into the continuity of health service in rural China. These issues are observed from the aspects of continuity of disciplines, institutions, relationship and health information. Policy recommendations include remolding the institutional relations in the three-tier rural health service network, constructing reasonable supporting environment and improving the health delivery quality.     

Utilisation of strategic analysis and planning by occupational therapy services

Many occupational therapists in practice can testify to the continually changing environments that impact on the delivery of effective services in the modern human service delivery system. It is within this context that occupational therapists are urged to regularly undertake strategic planning to keep track of and deal with these ongoing changes. In the present article, strategic analysis and planning will be discussed as a tool for occupational therapists in practice. The first step in strategic planning is an analysis of the external and internal environments of a particular service. The current article will provide an example of an environmental analysis as first step. This is followed by a discussion of the second step: the consideration of appropriate strategies and models of service delivery. The aim of the present article is to emphasise the importance of critical reflection by practitioners in order to adapt to the environmental changes influencing occupational therapy service delivery .     

Service integration and co-ordination: a framework of approaches for the delivery of co-ordinated care to children with disabilities and their families

This article clarifies the nature of 'service integration' and 'service co-ordination' and discusses how these aspects relate to the fundamental goal of providing co-ordinated care for children with disabilities and their families. Based on a review of the service delivery literatures in the fields of health, social services and rehabilitation, a framework is presented that outlines the scope of the co-ordination-related functions and activities encompassed in three common types of approaches to the delivery of co-ordinated care. These are a system/sector-based service integration approach, an agency-based service integration approach and a client/family-based service co-ordination approach. The functions outlined in the framework include aggregate-level planning of services (designed to map out the scope and plan for service provision in a community or geographical area), administrative functions (designed to ensure wise and equitable access to resources) and client-specific service delivery functions (designed to link clients/families to needed services). The framework is a tool that can be used to support policy making and decision making with respect to the design of efforts to provide co-ordinated care. It provides information about commonly used approaches and the essential elements of these approaches, which can be used in making choices about the scope and nature of an approach towards service integration/co-ordination.     

卫生服务人员激励机制国际经验综述

如何将卫生投入转变为有效的卫生服务提供,是我国医疗卫生改革及实现基本卫生服务均等化的重要问题。合理的激励机制能引导卫生服务人员的行为,促进从投入到有效服务提供的成功转化。本文基于国外卫生服务人员激励机制经验的分类总结,为我国卫生服务人员激励方式的设计提供建议。     

Food for thought: enabling and constraining factors for effective rural eating disorder service delivery

Objective: This study examined the effectiveness of an assessment and referral model of eating disorder service delivery in the Northern Rivers of New South Wales and its potential as a model for rural service delivery. Design: A qualitative evaluative research design used brief and extended semistructured interviews with clients, and surveys and semistructured extended interviews with service providers who either referred clients to the service or to whom clients were referred. Setting: A sole practitioner service based in a small non‐government women's health service in rural New South Wales. Participants: Clients of the service, all but one of whom was woman; service providers including general practitioners, private practice psychologists and social workers, dietitians, mental health service workers. Major outcome measures: Participant identified enabling and constraining factors which contributed to the effectiveness of the service model. Results: Whilst all service providers and most clients found the assessment process to be beneficial, they identified a number of constraining factors in the referral part of the service which undermined the effectiveness of the model of service delivery, especially for those with more complex or severe presentations. Conclusions: For a rural ED service to be effective, a number of enabling factors must be present including the capacity to provide: treatment services as well as assessment; a multidisciplinary team approach to assessment and treatment; and expert consultation and training to generalist practitioners, counsellors, hospital wards and other service providers.