规范诊疗行为的若干思考

医师具体诊疗行为对整个医疗服务过程及其质量和费用都产生巨大影响的关键环节.在以“用比较低廉的费用提供比较优质的医疗服务,努力满足广大人民群众基本医疗服务的需要“为目标的医疗保险制度下,规范医疗行为更应该成为医院内部管理以及医疗保险监督管理中的重点问题.……     

回归公立医院公益性的几点建议

强化公立医院公益性是政府在卫生领域追求的重要目标之一,也是卫生改革的热点问题.从卫生体制、医院自身、医生行为3方面分析公立医院公益性淡化的原因所在,就回归公立医院公益性提出了几点建议:包括强化公益性医疗服务、实行大型医院询查制度、确立仪器疾病检出率考核指标、加强医院"社会工作部"的建设、大小医院网络化等,从而消除现行的经济利益导向机制,形成鼓励医院追求社会效益,履行社会责任的激励机制.     

完善区域性基本医疗保险制度的对策分析

基本医疗保险制度的实施,体现了政府医疗保障体系的逐步建立和完善.如何正确认识和执行基本医疗保险制度政策,作为承担医疗卫生服务机构的医院还存在认识上的误区.应通过实施基本医疗保险制度,规范医疗行为和就医流程,达到医院医疗流程再造,促使医院医疗技术不断创新和持续发展的目标.     

医保支付方式由后付制向预付制改革对供方医疗服务行为影响的机制和发展路径

全民医保制度下,支付方式提供了影响供方医疗服务行为的手段,成为调节卫生资源配置的重要杠杆.医保支付方式由后付制向预付制的改革,通过财务风险的转移调整对医疗机构和医生行为的激励,控制供方诱导需求行为带来的费用上涨,成为医疗保险制度改革的重要方向.但其发挥作用的基础是医疗服务提供方对支付方式的反应.医疗服务目标的多维性、医...     

试论新农合定点医疗服务合同在规范供方行为中的作用

在新农合制度中使用定点医疗服务合同这类民事合同具有良好的出发点,供方在合同的约束下对于需方、管理方、新农合制度和自身内部都产生了一定的行为改变,这些行为改变绝大多数是积极正向的.目前合同的作用并未充分发挥,因为诸如法律文化习惯、农村医疗环境、合同成熟程度等在内的一些因素起到了制约作用.若想使该类合同在最大限度内发挥作用,还需对合同条款进行完善并辅以目标管理行政合同、公示、督导等手段共同对供方行为进行规范.     

医院经济管理流程标准化研究

以医院管理学、卫生经济学、福利经济学和标准化基础理论为指导,以病人需求和医疗行为为导向,以规范医疗行为,控制医疗费用不合理增长为目标,在借鉴医疗质量管理标准化的基础上,对医院经济管理存在的问题与难点进行了医院经济管理流程标准化的理论研究、实证分析与制度设计。旨在为我国公立医院经济管理流程再造提供标准依据,并为政府制定行业标准提供决策参考。     

农村医疗保障制度供给分析

在承认医疗服务具有公共物品或准公共物品特性的前提下，试图在制度经济学的框架下，结合现阶段我国农村具体实际，从新农合制度与农户医疗信贷行为之间互动关系的考察中提炼出政府重建和完善农村医疗保障制度的必然逻辑，最后提出了相关政策建议，以期在农村配套制度建设相对落后的现状面前，将农村医疗保障制度的建设作为契机，全面推动农村社会经济快速发展。     

基于博弈理论的DRG支付制度对医疗机构诊疗行为影响分析

目的:用博弈理论分析DRG支付制度对我国现行按项目付费制度下医疗机构诊疗行为的影响.方法:通过理论分析医疗机构的收入结构,构建并求解医疗机构诊疗行为的博弈模型,得到博弈模型的均衡解.结果:在按项目付费制度设计下,医疗机构会选择过度医疗的行为策略以获得更大的利润.在DRG支付下,医疗机构会从过度医疗的行为向缩减医疗的行为...     

以仁医理念引导公立医院的价值追求

目前,在筹资机制主要是市场机制的情况下,公立医院为追求经济收益,在积极提供医疗服务的同时,会出现过度医疗、大处方等不良医疗行为,造成社会医疗保险基金过度及不当的使用.     

医疗质量管理的决策与实践

医疗质量管理存在的问题①追求规模牺牲质量；②追求效益冲击质量；③追求项目忽略质量；④追求形式虚构质量，医疗质量管理决策中需要把握的4个重点，即全面素质培养、全面质量管理、全面宏观调控、全面制度建设。对医疗质量管理进行并行控制、危机控制、目标控制、缺陷控制。     

当代医学的异化及其人文精神重建

为了找出当代医学异化的根源,探索消除医学异化的人文精神路径,应该分析当代资本的逻辑和医学异化的特征。医学异化主要包括医学与科学精神的背离、医学与生命原则的背离以及医学与道德法则的背离。医学异化的主要根源在于:在市场经济条件下,部分医疗技术、医药技术和医疗器械的使用是在市场利益的驱使下进行的。消除医学异化,应该通过恢复医学的科学精神、生命原则和道德原则来重建当代医学人文精神。     

“互联网+医疗”模式下医务工作者职业行为分析

目的 为了解医务工作者对互联网医疗信息的使用现状及其与职业行为之间的联系。方法 随机调查徐州市区医务工作者900名。结果 85.9%认为互联网医疗信息对职业行为存在积极影响;58.6%支持医院发展网上诊疗系统;医疗机构网站和搜索引擎成为获取医疗信息的主要途径;学习方式由线下向线上转变;打电话、医院网站和微信公众平台成为医患互动的主要方式;不同人群关于互联网医疗的使用情况不同,随着年龄的增长,使用态度更加保守。结论 改变执业人员传统思维,培养互联网医疗专业技术人才,推动互联网在医疗行业的应用和发展。     

Pr?diktive Validit?t einer kurzen Skala zur subjektiven Prognose der Erwerbst?tigkeit (SPE-Skala) in einer Kohorte von LVA-Versicherten mit schweren Rückenschmerzen oder funktionellen Beschwerden der inneren Medizin

Predictive validity of a brief scale measuring the subjective prognosis of gainful employment (SPE-scale) in a cohort of blue collar workers with low back pain or functional syndroms of Internal Medicine. Objectives: Vocational (dis-)ability is a central concept in social medicine. Beside from medical factors psychological and system factors play a crucial role in determining vocational disability. The development of instruments assessing the prognosis of gainful employment is an important task in rehabilitation research.     

山东部分地区医生吸烟知识、态度与相关行为分析

目的了解山东省医生帮助吸烟者戒烟情况,为更好地开展控烟工作活动提供科学依据。方法在山东省济南市、聊城市和广饶县采用多阶段分层随机抽样的方法,抽取医生进行问卷调查。结果山东省医生现在吸烟率为15.0%。在给病人看病时,1267(84.5%)名医生会主动询问病人的吸烟情况。结论医生的控烟主动性较差,在劝导病人戒烟方面,缺乏足够的知识、积极支持的态度和戒烟技能。     

Factors Affecting Healthy Eating and Physical Activity Behaviors Among Multiethnic Blue- and White-collar Workers: A Case Study of One Healthcare Institution

Worksite health promotion programs can reduce prevalence of chronic disease among employees, but little research has been done to discern whether they meet the needs and incorporate the preferences of workers of different occupational types. The objective of this study is to examine differences in influences to healthy eating and physical activity and preferences for programs among multiethnic blue- and white-collar workers in Hawai‘i. A total of 57 employees from a major health care corporation in Hawai‘i participated. A mixed-methods approach was employed, in which findings from focus groups with white-collar workers (WCW) (n=18) were used to inform development of a questionnaire with closed and open-ended items for use with blue-collar workers (BCW) (n=39), whose jobs did not provide adequate time to participate in focus groups. Focus groups with WCW revealed that onsite availability of healthy food and fitness opportunities provided the most support for healthy eating and physical activity at work; work demands, easy access to unhealthy foods, and lack of onsite fitness opportunities were barriers; and lifestyle management was a topic of substantial interest. BCW cited the ability to bring home lunch and their (physically active) jobs as being supportive of healthy behaviors; not having enough time to eat and personal illness/injury were barriers; and chronic disease topics were of greatest interest. Knowing differences in influences to healthy eating and physical activity, as well as preferences for worksite wellness programming, among BCW and WCW, is important when planning and implementing worksite health promotion programs.     

深圳市参加与未参加劳务工医疗保险的卫生服务需求与利用比较研究

目的:了解参加与未参加劳务工医疗保险的劳务工卫生服务需求和利用的不同,为推动劳务工医疗保险制度的健康发展提供依据。方法:采用整群随机抽样的方法,分别对深圳市2080名参加与2554名未参加劳务工医疗保险的劳务工卫生服务需求、利用等进行问卷调查。结果:(1)参保人员两周患病率为25.53%,未参保人员两周患病率为22.24%;(2)参保人员两周患病就诊率为20.10%,未参保人员两周患病率为15.47%;(3)参保人员住院率为3.56%,未参保人员住院率为3.05%;(4)参保人员两周患病就诊单位主要是社康中心(42.44%)和街道医院(22.69%),未参保人员主要是个体诊所(32.45%)和社康中心(23.40%);(5)参保人员次均住院费用、间接费用分别为2723.4、837.7,未参保人员分别为1890.5、665.6。结论:参保人员两周患病率、两周患病就诊率均高于未参保人员;卫生服务可及性差;一些医疗机构存在诱导现象;参保病人流向较为合理。     

医疗行为与合法医疗行为的法律概念初探

目前，关于医疗行为与合法医疗行为的讨论引起了众多医院管理者和医务人员的关注。对医疗行为与合法医疗行为进行法律方面的探讨，提出医疗行为概念、特征和合法医疗行为概念、分类、特征与构成要件。     

Towards the proletarianization of physicians

The thesis of this article is that in general where most other workers were quickly and easily proletarianized, physicians - through the use of a variety of tactics at the disposal of some elite groups - have, until now, been able to postpone or minimize this process in their own case. Now, as a result of the bureaucratization which is being forced on medical practice as a consequence of the logic of capitalist expansion, physicians are slowly being reduced to a proletarian function, and their formerly self-interested activities subordinated to the broader requirements of the capitalist control of highly profitable medical production.     

The ecology of urban violence: its relationship to health promotion behaviors in low-income black and Latino communities

PURPOSE: The purpose of this review is to identify and examine relationships between exposure to violence and health promotion behaviors in low-income black and Latino groups. DESIGN: Based on computer surveys of the psychologic, public health, medical, and sociologic literature, approximately 90 previous studies of the impact of exposure to violence on psychologic functioning, perceptions of health and well-being, and health decisions and behavior were identified. This article reviews those studies that examine the relationships between experiences of violence and subsequent feelings of alienation, powerlessness, and hopelessness, and perceptions of health and well-being and studies that examine relationships between alienation, hopelessness, and powerlessness and health promotion behaviors. Studies of health promotion behavior that did not examine or address the impact of exposure to violence are not reviewed in this article. RESULTS: Violence affects low-income communities directly by contributing to rates of mortality, and indirectly by affecting health promotion behaviors. Exposure to violence can result in feelings of powerlessness, hopelessness, and alienation that significantly limit motivation, the extent of involvement, and persistence in overcoming barriers to health promotion behavior. CONCLUSIONS: Future researchers must consider the confounding effects of exposure to violence when investigating differences in health promotion behaviors for low-income black and Latino groups. Community empowerment programs that address the impact of violence and focus on developing control over life and health outcomes may be needed to successfully address the effect of violence on health promotion behavior in low-income, black and Latino communities.     

医务人员在医疗保险中的医疗行为与管理对策

针对医务人员在医疗保险中出现的医疗行为不规范所造成的医院经济损失、信誉下降和医疗纠纷等问题 ,结合医疗保险部门对定点医院采取的监督检查方式 ,探讨了医务人员在医疗保险过程中加强自身医疗行为规范与管理的对策。