加强财务管理保障医院持续发展

财务管理是医院经济工作的核心.医院所有的经营决策都必须以医院财务核算为依据,都必须依赖准确的会计数据、前瞻的财务预测和周密的财务分析;在经营决策实施过程更离不开财务部门合理的财务控制;而且,还需要用财务分析指标去评估其经营成果.因此,加强医院财务管理及提高医院财务管理水平是保证医院持续健康发展的重要条件之一.     

我省某三级乙等医院财务管理内部控制存在的问题及对策

医院财务管理是对医院资金的筹集、分配、使用、清偿等业务进行决策、计划、组织、执行和控制等工作的总称。医院内部财务控制是医院自我调节和自行制约的内在管理机制,处于医院管理的核心地位。内部财务控制是为了确保国家有关法律法规和规章制度的贯彻执行,维护国有资产的安全与完整,堵塞管理漏洞而制定和实施的一系列的控制方法,措施和程序。为加强财务管理内部控制,本文结合医院现状,对存在的问题进行分析并提出相应的对策。     

加强内部财务控制 促进医院经济发展

随着我国加入WTO，医疗市场竞争将日趋激烈，医院要在竞争中求生存、求发展，必须按照《会计法》、《内部会计控制规范》和《医院财务制度》要求，完善财务控制系统，加强医院自身的内部管理，提高经济管理水平和自身综合实力。财务控制，就是医院内部管理的重要一环。     

关于医院财务管理的若干探讨

财务管理工作是一项政策性、法规性和业务性很强的系统工作,在医院经营管理活动中占有重要地位,医院所有的经营决策都以医院财务核算为依据,在经营决策实施过程中合理的财务控制也是不可或缺的。随着医疗机构不断深化改革,面对激烈竞争的医疗市场,医院必须建立一个标准化和全面的医院财务管理系统,保证医院经济的健康发展,提高医院整体效益有着重要的意义。     

口腔科门诊医院感染危险因素及对策

目的探讨口腔科门诊医院感染危险因素及对策。方法提出口腔科门诊可能存在的医院感染危险因素,设立相应的措施和对策。结果采取相应的对策和措施,可以有效地预防控制口腔科门诊医院感染的发生。结论加强各级医务人员对控制医院感染重要性的认识、规范操作流程、重视医院感染的监测工作是有效预防控制口腔科门诊医院感染发生的关键。     

对单位与银行对账工作的探讨

随着市场经济的不断发展和完善，医院为了提高经济效益、加强竞争实力，加强了对内部的财务管理和内部控制。财务管理是基于医院经营过程中客观存在的财务活动和财务关系而产生的，它是利用价值形式对医院经营过程进行的管理，是医院组织财务活动，处理与各方面财务关系的一项综合性管理工作。管理工作的好坏，直接影响到资金的使用。内部控制制度是否健全有效，直接影响到医疗行为中经济活动的合法性，影响到医院的廉政建设。建立有效的医院内控制度，对于改善经营管理，防患于未然，保障医院的健康发展具有重要意义。这里所说的内控制度，主要是针对医院的货币资会的管理控制。     

医院财务档案管理中的主要问题探析

目的促进医院财务档案管理工作科学发展,加速实现医院管理现代化,全面提高医院服务质量和水平。方法系统分析医院财务档案管理工作现状。结果指出医院财务档案管理中普遍存在的共性问题。结论必须采取有针对性的解决措施。     

新形势下医院财务管理的思考

医院的财务管理是指对医院有关资金的筹集、分配、使用等财务活动所进行的计划、组织、控制、指挥、协调、考核等工作的总称,是医院经济管理的重要组成部分.随着经济的发展和改革开放的深入,财务管理已经渗透到医院的各个领域和医疗服务的各个环节之中.     

手术室医院感染控制与管理

目的探究手术室医院感染管理的措施,认识手术室工作的重要性。方法通过制定手术室医院感染管理的规章制度、加强对手术室医院的环境管理以及采取科学的方法来管理手术室医院的手术器械等措施,来对手术室医院感染进行控制与管理。结果实施了各项有利于手术室医院的措施,手术室医院感染得到了有效的控制。结论重视手术室医院管理,才能保证手术的质量与安全。     

加强医院内部控制降低医疗成本

医院财务管理,是指对医院有关资金的筹集、分配、使用等财务活动所进行的计划、组织、控制、指挥、协调、考核等工作的总称,是医院经济管理的重要组成部分[1].随着经济的发展和医疗卫生改革的深入,财务管理在医院管理中就显得越来越重要.在实际工作中,如何真正发挥财务管理在医院发展中的作用,是一个值得探讨的问题,现就医院如何加强财务内控建设,降低运行成本谈几点粗浅的认识.     

Evaluation of the introduction of an antimicrobial drugs formulary in a general hospital in Slovenia

Objective: To analyse the consumption of antimicrobials in a general hospital prior and after implementation of a drug formulary and the economic evaluation of the implementation.Method: Data were obtained from medical documentation collected over a one-month period for all in-patients in four major hospital departments prior to and after the implementation of a drug formulary. The ATC/DDD methodology was used to analyse consumption of antimicrobials. Patients were grouped in therapeutic groups according to their disease and the clinical and economic outcome of the implemented intervention was estimated. Retrospectively, pharmacoeconomical cost–effectiveness analysis was undertaken from the hospitals point of view.Results: The overall use of antimicrobials after implementation in DDD/100 bed-days increased by 16.8%. However, the drug formulary was successfully implemented in 1999, saving 33.7% DDD/100 bed-days of antimicrobials restricted by the formulary. At the same time, treatment time was shortened by 26.5%, with an overall saving of 35.1% per patient.Conclusions: The importance of a drug formulary for antimicrobials was demonstrated in terms of its clinical and economic outcome. A practical case of co-operation between physicians and clinical pharmacists in such a project was also revealed.     

“4＋7”带量采购对内蒙古自治区人民医院口服抗肿瘤药原研药和仿制药使用情况影响

目的 分析“4＋7”带量采购政策对内蒙古自治区人民医院口服抗肿瘤药品原研药和仿制药使用的影响，为临床药学服务和医院的药事管理提供依据。方法 采用Excel软件计算口服抗肿瘤药品的使用数量、金额、价格、用药频度（DDDs）、限定日费用（DDC）、占比、增幅、降幅，及仿制药替代率、费用节省率进行分析。结果 “4＋7”带量采购实施后，原研药和仿制药价格出现了不同幅度的降价，其中中选品种来曲唑单品价格降幅最大，降幅超过60%，原研药中价格降幅最大的是阿斯利康制药有限公司生产的吉非替尼，达30%。“4＋7”带量采购实施后，甲磺酸伊马替尼、替吉奥、来曲唑、阿那曲唑、卡培他滨、替莫唑胺仿制药DDDs均增加，而销售金额均下降。吉非替尼仿制药DDDs增幅最大，达74.17%，销售金额则增加57.38%。甲磺酸伊马替尼原研药受带量采购政策影响，DDDs和销售金额均增加，而其他相应的原研药的DDDs和销售金额均减少。“4＋7”带量采购的实施进一步提高仿制药的使用率，为医保费用节省899万元，费用节省率为49.99%。结论 带量政策实施后，药品费用支出减少，切实减轻了部分患者的用药负担。     

浅谈我院药品零差价后收支再平衡的建议与对策

目的:考察我院实行药品零差价政策后财务收支的现状,并对收支再平衡提出自己的建议与发展对策,为医院可持续发展建言献策。方法:从我院的发展现状着手,论述了实行药品零差价对我院发展的意义,包括惠及民生,改变了以药养医的不利局面,改变了医院经济收入的结构,对医院服务质量提出了更高的要求,并加强了对药品的有效管理。在收支再平衡的建议与对策上,做到:开源节流,节约医疗成本;提高服务质量,提升服务水平;开展技术合作,攻克技术难关;提升医生技术价值,调整服务结构;规范药品管理,改变用药思路,并大力发展中医药国粹。结果:若实行了上述合理化的建议与发展对策,能够改变我院实行药品零差价政策后收支不平衡的现状,完全实现我院财务收支再平衡。结论:通过开源节流,提高服务质量,调结构、转方式等措施,可进一步加强医院的内部管理来提高医院自身竞争力和综合实力,努力实现我院的可持续发展。     

Potential economic effets of a brand standardization policy in a 1000-bed hospital.

The potential economic effects of a brand standardization policy on 50 multiple source, nonproprietary drugs in a 1000-bed hospital which uses a unit dose drug distribution system were studied. Inpatient drug usage cost and inpatient drug inventory cost for the year 1974 were compared under the existing nonformulary system and a simulated formulary system of brand standardization. Drug usage cost was defined as expenditures made by the study hospital for drugs which were administered. Drug inventory cost was defined as the dollar value of drug inventory being stored for use in the hospital. Potential saving in excess of $35,000 for drug usage cost and $9,000 for drug inventory cost could have been realized with a brand standardization policy on 50 nonprietary drugs. The differences in costs were significant at the 0.005 level. It is concluded that a brand standardization policy can be effective means of reducing drug usage cost and drug inventory cost in a large hospital.     

Reducing Energy Consumption in Pharmaceutical Production Processes: Framework and Case Study

Purpose

This paper aims to present a novel framework for reducing energy consumption in pharmaceutical manufacturing processes, with a primary focus on parenterals production. The framework supports (a) the design of optimal energy-saving solutions, (b) the execution and implementation and (c) the comparison of designed and actual performance as a post-implementation control. In selecting promising options, multiobjective criteria are defined for comprehensive decision-making which considers not only energy savings, but also other aspects such as good manufacturing practice (GMP), risk, and workers’ safety.

Methods and Framework

In the framework, five phases were defined in total, with three for design and two for execution and control, respectively. In the three design phases, options are generated, evaluated and selected step by step, with appropriate evaluation criteria covering financial as well as non-financial aspects. The roles of various stakeholders, e.g., Operations, Engineering, or Quality Assurance, are defined for each phase in order to enable smooth and certain decision-making.

Case Study and Results

A case study was performed in the parenterals production plant at Hoffmann-La Roche in Kaiseraugst. Twelve energy efficiency ideas were generated and, after the screening and selection process, the three most promising options from the multiobjective Pareto optimization were implemented to reduce the total plant’s energy consumption by 2.5 %.

Conclusions

The framework enabled the systematic generation and selection of various options, which helped in the allocation of company resources in a prioritized and thus effective manner.     

Evaluation of an antibiotic intravenous to oral sequential therapy program

AIM: This study was designed to analyse the drug consumption difference and economic impact of an antibiotic sequential therapy focused on quinolones. METHOD: We studied the consumption of quinolones (ofloxacin/levofloxacin and ciprofloxacin) 6 months before and after the implementation of a sequential therapy program in hospitalised patients. It was calculated for each antibiotic, in its oral and intravenous forms, in defined daily dose (DDD/100 stays per day) and economical terms (drug acquisition cost). At the beginning of the program ofloxacin was replaced by levofloxacin and, since their clinical uses are similar, the consumption of both drugs was compared during the period. RESULTS: In economic terms, the consumption of intravenous quinolones decreased 60% whereas the consumption of oral quinolones increased 66%. In DDD/100 stays per day, intravenous forms consumption decreased 53% and oral forms consumption increased 36%. CONCLUSIONS: Focusing on quinolones, the implementation of a sequential therapy program based on promoting an early switch from intravenous to oral regimen has proved its capacity to alter the utilisation profile of these antibiotics. The program has permitted the hospital a global saving of 41420 dollars for these drugs during the period of time considered.     

实施“门诊患者医保持卡实时结算”的医院财务内部控制

“门诊患者医保持卡实时结算”是患者门诊医疗费用中,按照医保政策,除患者自付部分之外的费用由医院先期垫付,然后与医保部门结算的模式。本文笔者从财务的角度,详细阐述了持卡实时结算的财务流程、财务风险,并提出了有针对性的财务内部控制措施．以保证持卡实时结算模式下的医院财务安全。     

我院实施“限制药费收入最高比例”措施控制患者医疗支出效果评价

目的:为医院采取有效措施控制患者药费和医疗支出提供参考。方法:对我院实施"限制药费收入最高比例"措施前、后药费收入相关数据进行统计和分析。结果:措施实施后住院药费收入比例、门诊药费收入比例和药费总收入比例分别下降5.93%、1.15%、3.48%,且多个科室药费收入均未超出我院规定比例,医师处方行为进一步规范。结论:"限制药费收入最高比例"措施可显著控制患者药费和医疗支出。     

集中带量采购对上海市松江中心医院他汀类药物使用情况的影响

目的：分析国家药品集中带量采购以来不同时间段上海市松江区中心医院（简称我院）他汀类调脂药的使用情况，探讨该政策对我院他汀类调脂药使用的影响，为推动制定和完善政策、提升医院药事管理水平提供参考。方法：汇总我院“4+7”带量采购、第二批国家集中带量采购及第三批国家集中带量采购后7个月门诊他汀类药的使用数据和政策实施前同期的使用数据，采用药物经济学方法，分析集中带量采购政策对我院他汀类调脂药的使用数量、销售金额、用药频度（DDDs）及限定日费用（DDC） 的影响。结果：国家药品集中带量采购政策实施后，我院他汀类调脂药中选品规单价显著降低，未中标品种的单价未变；他汀类调脂药使用量逐步增长而销售金额却下降明显，其DDDs逐年升高，DDC有不同程度降低。结论：药品集中带量采购工作在我院执行情况良好，政策的实施不仅让他汀类调脂药中选品规的日均费用降低明显，使患者和医保的经济负担大大减轻，同时也有利于优化调整药品价格。     

Contextual determinants of alcohol consumption changes and preventive alcohol policies: a 12-country European study in progress

Beginning with France in the 1950s, alcohol consumption has decreased in Southern European countries with few or no preventive alcohol policy measures being implemented, while alcohol consumption has been increasing in Northern European countries where historically more restrictive alcohol control policies were in place, even though more recently they were loosened. At the same time, Central and Eastern Europe have shown an intermediate behavior. We propose that country-specific changes in alcohol consumption between 1960 and 2008 are explained by a combination of a number of factors: (1) preventive alcohol policies and (2) social, cultural, economic, and demographic determinants. This article describes the methodology of a research study designed to understand the complex interactions that have occurred throughout Europe over the past five decades. These include changes in alcohol consumption, drinking patterns and alcohol-related harm, and the actual determinants of such changes.