基于系统动力学的过度医疗问题博弈分析

过度医疗是一个世界性难题,被认为是造成医疗费用上涨过快,卫生资源严重浪费,医患关系不断恶化等结果的主要原因。本文基于演化博弈思想与系统动力学理论,在信息不确定的条件下,对过度医疗问题进行建模分析,揭示过度医疗问题博弈双方的动态特性,利用系统动力学为解决过度医疗问题提供一个定量定性相结合的政策仿真平台,从而为缓解“看病难、看病贵”问题提供可参照的依据,为我国医疗卫生事业的改革提供策略。     

浅析基本医疗保险的卫生资源消耗与医疗服务关系

探讨基本医疗保险的卫生资源与医疗服务的关系,对医疗保险中,患者医疗需求过度、卫生资源消耗过度、医生医疗服务过度的现象进行了分析,并对如何解决这些问题提出了可行的方案和建议,医保政策还待不断地调整和完善.     

间断均衡理论视阈下的医疗暴力治理政策变迁审视

在医疗卫生体制改革的影响和焦点事件的触发下,中国医疗暴力的治理政策变迁呈现出间断均衡演进的特征,并逐渐从决策者主导型间断到参与式间断,从单一决策场域到协同决策场域,从过度保护单方利益到以维护公共利益为核心。未来,欲实现公共政策对医疗暴力的有效治理,应在政策决策中加强各方参与,客观冷静地分析作为政策问题的焦点事件,以细致清晰的政策表达克服旧有政策惯性的不良影响。     

控制过度医疗提升服务质量

文章对过度医疗问题的成因、后果及控制进行了研究。探讨了如何以“零缺陷”医疗质量管理为契机,加强防范过度医疗,提升服务质量。提出了在院内管理中引入以社会保险和商业保险为主体的第二方和第三方监督机制,从而保证适度医疗。     

妇产科“过度医疗”之痛

"过度医疗"历来是医师执业中的大忌,虽然此问题早为大家所关注,但过度医疗的成因十分复杂,涉及医疗技术水平、职业道德、各种利益驱动以及管理体制等问题,因此,"过度医疗"至今仍然不同程度存在。此篇专家笔谈,作者引证文献,从较早年到现今,对妇产科中6个方面的"过度医疗"进行了深入的分析,令人深思,期望对读者有所启迪,以采用恰当的诊疗方法为患者解除疾病的痛苦,避免"过度医疗"之痛!     

潍坊市落实一般诊疗费政策的措施与效果

实施基本药物制度和一般诊疗费政策是医药卫生体制改革的重要举措,是对基层医疗机构的两项支持政策,可以充分体现医疗服务合理成本和医疗技术劳务价值,解决过度用药和以药补医问题。自2012年1月1日起,潍坊市按照新医药卫生体制改革配套文件的要求,已实施基本药物制度,并在开展新型农村合作医疗(新农合)门诊统筹的基层医疗卫生机构执行一般诊疗费政策。     

我国现行基本医疗服务界定的弊端及其重新界定的方法与政策

现行医疗保险政策对基本医疗服务的界定不仅边界模糊,而且缺乏可操作性。由此造成许多严重的问题,如公众对卫生资源有过度利用的倾向和政治压力以及政府对医疗服务的过度保障。将基本医疗服务界定为:由社区卫生服务中心提供的医疗卫生服务,以及经社区卫生服务中心审核转诊到高级别医疗机构的医疗服务。由于医疗服务产品的特殊性和复杂性,重新界定基本医疗服务将会有效地降低基本医疗保险中各利益相关方的信息不对称以及由此产生的机会主义动机与行为扭曲,从而改善基本医疗保险制度保障的公正性,并通过遏制医疗费用的过度膨胀而提高其效率。     

规范医疗行为须对症下药

开展为期一年的不合理医疗检查专项治理行动,重点整治无依据检查和重复检查;建立以公益性为导向的绩效分配制度,不得设置可能诱导过度检查和过度医疗的指标,并将其与医务人员收入挂钩;将过度医疗检查问题纳入医疗机构纪检监察机构日常监督的重要内容……日前,国家卫生健康委等八部门联合印发《关于进一步规范医疗行为促进合理医疗检查的指导...     

论完善基本医疗补偿对遏制过度医疗的作用

卫生总费用的持续快速增长已成为困扰世界各国的重要公共管理问题.在我国,因医疗服务补偿不合理导致的过度医疗是造成社会医疗卫生总费用快速增长的重要原因.立足国情实际对过度医疗做以全新理解,并就完善基本医疗服务补偿机制对遏制过度医疗的作用进行研究,对解决基本医疗服务问题和实现新医改目标具有重要现实意义.     

信息不对称下公立医院过度医疗的治理

过度医疗作为医疗实践中的不良现象,是引发医疗纠纷和“看病贵”的重要原因。从信息不对称的角度,通过分析我国公立医院过度医疗治理现状,找出当前我国公立医院过度医疗治理存在的问题,提出信息不对称下公立医院过度医疗的治理模式。以期从根本上遏制公立医院过度医疗问题的发生。     

Trends in meningococcal disease in Italy in 1988

Meningococcal disease in Italy decreased 15% in 1988 from the previous year (290 vs. 342 cases). The decline was particularly evident in military cases (1.7/100,000 in 1988 vs. 5/100,000 in 1987) reflecting the full coverage of bivalent serogroup (A + C) meningococcal polysaccaride vaccine in army recruits, achieved since January 1988. The highest proportion of cases was seen in people older than 25 years of age (25%). Serogroup C constituted 60% of the isolates, while 19% belonged to serogroup B. The proportion of strains resistant to sulphonamides was 45%, while 15% were resistant to Minocycline and none to Rifampin. Out of the five military cases, only one (due to serogroup C) was attributable to the vaccine failure. A single coprimary case, but no secondary cases occurred among civilians. These findings are consistent with the trends reported in Italy in the previous years.     

Benzene in blood and phenol in urine in monitoring benzene exposure in industry

Determinations of benzene concentration in blood and of phenol in urine were made by head-space gas chromatography techniques on samples taken near the end of the work day from two groups of workers potentially exposed to low levels of benzene in the work-place atmosphere. Preliminary results suggest that benzene in blood is more reliable than phenol tests for assessing both exposure and uptake of benzene. Normal values of phenol in urine (10 mg/liter or less) were found in nearly all those cases in which benzene was detected in the blood.     

2015年郑州市饮用水放射性水平状况调查

目的了解郑州市不同地区、不同季节、不同水源类型的放射性水平。方法分别于丰水期和枯水期采集郑州市区黄河水源水、井水源水、丹江口水源水、出厂水和末梢水各一份;以县为单位,每单位采集出厂水、末梢水、水库水、河水、井水各1份,按《生活饮用水生活标准检验方法》(GB/T 5750.13-2006)检测饮用水中总α和总β放射性水平,依据《生活饮用水卫生标准》(GB 5749-2006)进行判定。结果丰水期、枯水期水体总α、总β放射性水平均低于国家标准限值。结论郑州市不同水源类型均处于正常的天然放射性本底水平。     

Occupational stress in nurses in psychiatric institutions in Taiwan

Nurses are known to be exposed to occupational stress. However, occupational stress is not well documented for nurses in psychiatric institutions in Taiwan. A cross-sectional study was conducted to explore the work-related stress and risk factors of nurses in psychiatric institutions in Taiwan. A structured questionnaire was distributed to nurses at five state-owned psychiatric hospitals in Taiwan in 2001. Demographic information, working environment, and personal health status were inquired. Occupational stress was assessed based on the Chinese version of Job Content Questionnaire (JCQ). General health status and mental health were evaluated by the International Quality of Life Assessment Short Form-36 (IQOLA SF-36). A total of 573 questionnaires were disseminated to nurses and 518 (90.4%) were satisfactorily completed by nurses, including 408 female full-time nurses who had been in their current work for more than 6 months. In the past one month, 17.2% of nurses reported being under significant stress often or always. Assault episodes were reported by 45.1% of nurses in the past 6 months. Among the nurses, 16.9%, 25.2%, 50.0%, and 7.8% belong to the "High strain", "Low strain", "Active", and "Passive" groups, respectively. Perceived occupational stress was associated with young age, widowed/divorced/separated marital status, high psychological demand, low workplace support, and threat of assault at work. Lower general health score was associated with low job control, high psychological demand, and perceived occupational stress. A lower mental health score was associated with low job control, high psychological demand, low workplace support, and perceived occupational stress. We concluded that nurses in psychiatric institutions are under significant stress related to work factors.     

Changes in nursing administration in supporting transplantation in Brazil

This historical and bibliographic study aimed to understand how Nursing was organized to support care in transplantation. The HISA, LILACS, BDENF, PERIENF and DEDALUS databases were consulted, and thirteen references were found, ten of which were scientific articles, two were master's dissertations and one was a doctoral thesis. The span of time chosen for study ranges from the date of the first kidney transplant in Brazil (1965), to the date of publication of the last scientific article found in the databases mentioned above (2003). After reading these articles, the ones that were similar in topic were grouped together, thus creating the thematic axis for the presentation of the results. The results showed that the Nursing profession has played an important and active role in transplants ever since the first procedure in 1965.     

2019年中国肿瘤流行病学研究进展

恶性肿瘤已成为中国居民的主要死因之一。近些年来,中国政府积极推进肿瘤预防和控制领域的研究工作,取得了很大的进步。本文简要汇总中国在肿瘤流行病学领域的研究进展,具体包括2019年的肿瘤负担、癌症危险因素及其干预、筛查和早期发现、癌症防治专项行动(2019-2022年)方案等方面,以期为我国肿瘤防治工作的有效开展提供技术支撑和理论依据。     

2012年绵阳市蔬菜中农药残留状况

目的 了解绵阳市2012年市售蔬菜中农药残留情况,为食用蔬菜监管提供依据.方法 全部样品均按照GB/T 5009-2003的方法进行农药的残留检测.依据GB 2763-2005《食品中农药最大残留限量》进行判定.结果 2012年共检测蔬菜165份,农药检出率和超标率分别为72.12％和23.64％.豆类、根茎类、叶菜类、瓜果菜类和食用菌类蔬菜检测农药残留超标率分别为8.00％、23.53％、36.00％、5.26％和27.03％,差异有统计学意义(x2=11.41,P＜0.01).不同种类农药超标率差异有统计学意义(x2 =62.42,P＜0.01).夏季和冬季蔬菜农药超标率差异无统计学意义(x2=3.44,P＞0.05).结论 绵阳市叶菜类蔬菜中农药残留情况较为严重,应采取有效措施,加强蔬菜的监督管理,从源头禁止高毒农药的使用,加大蔬菜种植、销售环节的监测,确保市民食用蔬菜的安全.