门诊部领导者的职责

1.保障为医疗需求者提供高水平的医疗服务,实现需求者高兴而来,满意而去;2.组织全体工作人员各就各位,各劲其责,实现门诊系统惯性运行,并实现有效地随时调动;3.经常保持医疗仪器及设备     

社区卫生服务机构所有权和服务私有化探讨

在国家卫生政策和高医疗保险覆盖的情况下,社区卫生服务所有权和服务私有化可以实现,并有利于医疗资源的合理分配,同时也促进国家对社区卫生服务的规范化管理。目前大部分社区卫生服务机构运行效率低下,没能提供高效社区卫生服务,控制医疗费用上涨。本文从社区卫生服务功能及与其他组织之间关系及社区卫生服务运行情况、目前我国卫生政策、医疗保险政策等方面探讨社区卫生服务所有权和服务私有化的可能性。     

俄罗斯医疗联合体的活动原则和管理

医疗联合体开展活动的原则 1.在开展业务活动时,联合体应遵照以下两个协约:一是联合体与卫生部门签订的为居民提供医疗服务协约;二是联合体与企业和组织签订的向其职工提供医疗服务协约。 2.联合体的业务活动实行经济核算制。联合体提供医疗服务,开展社会活动及支付劳动报酬所需资金,其来源主要包括:因向指定的居民提供免费医疗服务而从卫生部门得到的资金及向居民、企业和组织提供有偿服务而获得的资金。这两部分资金,联合体可以自行酌情支配。     

集约管理与医疗设备维保信息管理系统的应用

医疗设备维护与质量控制紧密结合的维护保障业务运行模式与充分调动维修资源的集约化设备维护保障管理机制,为现代医疗设备提供了全新的策略。本文对医疗设备维护保障的组织方法、完成结构、管理体系及工作流程等进行整体性设计,构建了维护保障业务运行和管理机制的系统框架。并结合人力资源、技术规范、工作标准和信息管理,开发了医疗设备维护保障服务管理信息化系统,利用信息技术来提高业务管理水平,增强对临床医疗的服务和支持能力。     

管理医疗组织的功能

管理医疗组织实际上是医疗保险的一种特殊形式，它不但分担组织内成员的医疗费用，而且把筹集资金和提供医疗服务有机地结合起来。因此，管理医疗组织同时具备了保险和医疗两个功能。组织内的成员需要向管理医疗组织定期缴纳保险费，政府也通过财政给予补贴和从政策上给予倾斜。管理医疗组织拥有自己的诊所和医院，或者它雇佣医生或与诊所、医院签订合同，然后这些医疗单位向组织内成员提供医疗服务。管理医疗组织为了有效控制医疗成本，要求其成员只能在组织内所属的医疗单位或与组织签订合同的医疗服务单位中进行选择，成员不能随意选择医疗单位。     

上海市三级甲等综合性医院医疗服务能力变化趋势分析

随着社会的发展和人民生活水平的提高,人民群众的医疗需求快速增长,同时,医疗费用也出现了快速增长,"看病难"、"看病贵"使得我国医药卫生体制改革以及三级甲等综合性医院的运行效率成为社会关注的焦点.现通过回顾1997年至2006年10年间上海市10所三级甲等综合性医院的发展规模及其所提供的医疗服务量的变化情况,了解医院的医疗服务提供能力和医护人员的工作负荷,分析影响医院行为的政策环境及医疗服务市场环境,为公立医院建改革提供参考.     

我国医疗服务市场失灵的制度解释：基于组织竞争的视角

医疗服务是一个先天性失灵的市场,需要通过不断改进管制手段才能完善起来.我国医疗资源低效率配置反映了医疗服务市场的不完善.从制度角度分析医疗服务管制及管制方式,医疗服务组织促进专业化管制,专业化管制又影响医疗服务组织结构、规模及技术,组织的核心技术在专业化管制下不断延长,服务交叉,组织间竞争加剧.而且选择按项目支付的价格管制,使医疗服务组织能够从增加设备和服务项目的激励中获得垄断力;并且按项目付费削弱公立医院与基层卫生机构之间的合作意愿,强化了公立医院垄断,减少了医疗产业分工,从而降低了医疗服务市场活力,导致了医疗资源低效率配置.     

医院医疗仪器设备档案的建立管理与使用

医疗仪器设备档案是医疗设备运行的全部历史记录,它的建立、管理与使用为医疗设备的合理、高效运行、维修、保养、科学管理提供服务,为医院医疗质量、技术水平的提升提供保障,完善档案内容,提高其质量和功效将对医院发展起重要作用。     

三种支付方式促进健康整合的作用分析

全球范围内疾病谱和健康领域的变化以及医疗服务体系的碎片化都要求推进健康整合。支付方式可以通过经济激励影响供方行为,成为促进健康整合的有效工具。先行国家的经验表明服务协调付费、按绩效付费和捆绑支付这三种支付方式同责任医疗组织、"医疗之家"等新型服务提供方式,能通过对医疗服务提供方的经济激励减少医疗资源浪费和提高医疗质量,有助于促进卫生服务组织的协作,提高服务提供的连续性,最终有利于卫生服务整合和机构整合。     

国外社区医疗运行制度研究综述——城市社区医疗及其就诊问题系列研究（二）

通过有关国外社区医疗和社区卫生服务的研究文献,分析国外社区医疗与社区卫生服务的关系和国外社区医疗就诊制度的显著性特点,总结国外社区医疗运行制度的成功经验及其存在不足,为我国发展城市社区医疗服务和完善社区医疗就诊制度提供借鉴。     

The role of provider supply and organization in reducing racial/ethnic disparities in mental health care in the U.S.

Racial and ethnic disparities in mental health care access in the United States are well documented. Prior studies highlight the importance of individual and community factors such as health insurance coverage, language and cultural barriers, and socioeconomic differences, though these factors fail to explain the extent of measured disparities. A critical factor in mental health care access is a local area's organization and supply of mental health care providers. However, it is unclear how geographic differences in provider organization and supply impact racial/ethnic disparities. The present study is the first analysis of a nationally representative U.S. sample to identify contextual factors (county-level provider organization and supply, as well as socioeconomic characteristics) associated with use of mental health care services and how these factors differ across racial/ethnic groups. Hierarchical logistic models were used to examine racial/ethnic differences in the association of county-level provider organization (health maintenance organization (HMO) penetration) and supply (density of specialty mental health providers and existence of a community mental health center) with any use of mental health services and specialty mental health services. Models controlled for individual- and county-level socio-demographic and mental health characteristics. Increased county-level supply of mental health care providers was significantly associated with greater use of any mental health services and any specialty care, and these positive associations were greater for Latinos and African-Americans compared to non-Latino Whites. Expanding the mental health care workforce holds promise for reducing racial/ethnic disparities in mental health care access. Policymakers should consider that increasing the management of mental health care may not only decrease expenditures, but also provide a potential lever for reducing mental health care disparities between social groups.     

Ambulatory care in the new millennium: the role of consumer information

The past decade has been marked by extensive change in the organization of health care delivery systems (the "supply side" of health care). There has been relatively less change in the nature of the health care consumer (the "demand side" of health care). The emergence of the Internet as a consumer health care technology, however, should significantly affect the nature of demand. The Internet will prepare health care consumers to better express and evaluate care against their preferences. This will create additional pressure on--but significant positive opportunity for--ambulatory care and ambulatory care providers.     

Implementation of health insurance reform

Authors expose in the first part of this article practical modes to implement the health insurance reform under the angle of the mastery of care expenses, at the micro and the macroeconomic levels. Thus they pass in review the different possibilities to master expenses, at the supply and the demand sides, by identifying advantages and risks of each of they and by specifying orientations of the health insurance reform in this area: the moderating ticket, contractual payment methods of hospitals and health professionals, the path of care, the refund of care expenses, the rationalization of consumption of medicines and complementary examinations and the harmonious development of care supply by a better public and private mix. A particular accent is put on preliminaries and implementation conditions of the prospective payment of providers and organizational conditions of care provision, from general practitioner that would become the main entry of the care system. In a second part, authors pass in review organization and management conditions of social security bodies, needed for the health insurance reform implementation. On the basis of decentralization and a three levels organization (local, regional and central), social security bodies will put in place the most appropriate organization to insure a steady efficient implementation of the health insurance reform, in dialogue with stakeholders. Consultative committees at regional and central levels, regrouping all the intervening in the health insurance, will be instituted. The sought-after objective through this organization is to administer the health insurance, at the strategic, decisional and operational levels, with suppleness, as a changing and dynamic project, in function of flexibility imperatives necessary for the reform implementation.     

Investigating innovation in complex health care supply networks: an initial conceptual framework.

This paper explores the constraints and enablers of the process of innovation within the context of UK health care supply networks. Building on a comprehensive literature review of established and recent innovation and supply network research, the paper presents three levels of supply network analysis: sector level supply networks, focal organization supply networks and dyadic supply relationships. The paper reports on the first round of fieldwork conducted with 12 different health care organizations. The three different levels are applied during analysis and the findings are considered in terms of the key themes that have emerged and the practical and theoretical challenges that they represent.     

求实创新做好为部队服务工作

为了从医疗机构角度研究军队伤病员医疗服务需求与供给的变化趋势,探讨医院住院军人的医疗服务需求与供给的平衡关系．本文对1998年到2002年五年期间某军区总医院住院军人医疗服务需求和供给进行了调查研究,结果显示军人医疗费用消耗以人均每年1000元的速度递增,军人医疗费用供给也呈逐年上升趋势,供给的增长主要依赖医疗机构对外经济收人。同时本文提出了提高军队人员医疗保障水平的四项创新措施：一是利用社会资金,提升军队医疗保障实力;二是合理投入,分类分层提供经费保障;三是改进服务．改善军队人员就医环境;四是加快成果转化,让军队伤病员从科技成果转化中受益。     

Intermunicipal health care consortia in Brazil: strategic behavior, incentives and sustainability

This article studies strategic behavior in municipal health care consortia where neighboring municipalities form a partnership to supply high-complexity health care. Each municipality partially funds the organization. Depending on the partnership contract, a free rider problem may jeopardize the organization. A municipality will default its payments if it can still benefit from the services, especially when political pressures for competing expenditure arise. The main result is that the partnership sustainability depends on punishment mechanisms to a defaulting member, the gains from joint provision of services and the overall economic environment. Possible solutions to the incentive problem are discussed.     

Fend for yourself. Systemic failure in the Dominican health system

Despite relatively high levels of total spending and enormous growth in the supply of services during five decades, the Dominican health system demonstrates low performance in addressing the health needs of its population, ensuring acceptable quality of care, reducing the financial burden of health care on the poor, or providing adequate insurance coverage for those with the ability to pay. The paper analyzes deficiencies in financing, organization and delivery of health services in both the public and private sectors. The paper argues that government failure has undermined the health system and health care. Despite calls for reforms, attempts to restructure the system have not yet taken shape.     

The community health volunteer scheme in India: An evaluation

In this paper, we have placed the discussion of community health volunteer (CHV) scheme within the larger context of the evolution of primary health care organization in India. Drawing on a national evaluation study and a micro village level study, we have outlined the key issues in the design and implementation of the CHV scheme. These issues relate to the range and quality of services, the characteristics of clients served, nature of health problems attended, community participation, extent of help rendered by CHV to PHC staff, and problems of logistics and supply of manuals, kits and medicines.Our analysis shows that the CHV scheme has succeeded in bringing primary curative care to the doorsteps of the people. To a smaller extent, it has also helped in improving related services such as family planning, immunization and detection and treatment of malaria. Both the village community and the field staff of the regular health care organization find the CHV as a useful link between the community and the primary health center. Also CHVs are not confining to only a privileged few but they are catering to a cross-section of different caste and class groups in the village community.     

Provision of ambulatory health services in Poland: a case study from Krakow

This study provides a comprehensive picture of the organization and delivery of ambulatory health care services in Poland. A main finding of the study is that, following the introduction of health insurance in 1999, the newly introduced Sickness Funds have become the main players in the medical services market, introducing new bidding procedures and contracts for provision of medical services. Contracts, and negotiations which precede them, have introduced elements of market competition, which has affected the number and types of services provided by health care centers operating under a contract. The health financing reforms have led to an even playing field for public and non-public providers, marked by a proliferation of structurally smaller health units. The introduction of a market environment has changed the way in which providers are compensated, with a discernible shift away from salary-based systems to capitation and fee-for-service compensation. The analysis of the provider market for outpatient care underscores the importance of understanding the organization and supply of health services, particularly insofar as it relates to the design of appropriate financial and other incentives for providers of health services and of policy interventions necessary for achieving systemic changes.     

Improving access to health care in Latino communities.

Public debate about health care reform often focuses on the need for health insurance coverage, but in Latino communities many other barriers also inhibit access to medical care. In addition, basic public health services often go underfunded or ignored. Thus, health care reform efforts, nationally and in each State, must embrace a broader view of the issues if the needs of Latino communities are to be served. This report reviews and summarizes information about the mounting problems Latino communities face in gaining access to medical care. Access to appropriate medical care is reduced by numerous financial, structural, and institutional barriers. Financial barriers include the lack of health insurance coverage and low family incomes common in Latino communities. More than 7 million Latinos (39 percent) go without health insurance coverage. Latinos without health insurance receive about half as much medical care as those who are insured. Structurally, the delivery system organization rarely reflects the cultural or social concerns of the communities where they are located. Therefore, providers and patients fail to communicate their concerns adequately. These communication problems are exacerbated by the extreme shortage of Latino health care professionals and other resources available. Institutional barriers often reflect the failure to consider what it means to provide good service as well as high-quality medical care. Reducing these barriers to medical care requires modifying governmental and institutional policies, expanding the supply of competent providers, restructuring delivery system incentives to ensure primary care and public health services, and enhancing service and satisfaction with care.