发挥医改主力军作用推动医疗集团一体化发展

2017年2月底,孝义市被确定为山西省首批县乡医疗卫生机构一体化改革试点,围绕全市经济社会发展大局和医疗集团定位及新时期县域卫生工作发展理念,进一步确定了"医疗机构得发展、医务人员受鼓舞、人民群众得实惠"的改革目标,出台资源配置、财政投入、补偿机制、人事分配、绩效考核等相关配套政策,形成了高效推进"三医联动"、分级诊疗和集团发展的框架路线图.其中将人力资源统筹管理作为重中之重,充分发挥医务人员参与医改的主观能动性,实质化推进医疗集团一体化各项工作.     

绩效考核与奖金分配在营养科管理中的应用探讨

目的探讨绩效考核与奖金分配方案在营养科管理中的应用及效果。方法首先制定绩效考核方案,将所有工作项目分别赋予不同的权重,根据每位营养师的工作量计算得分和比例,最后按照绩效考核结果进行奖金分配。结果单月奖金比例最高值和最低值相比,差异有统计学意义(t=13.71,P<0.001);营养师之间单月奖金比例比较,差异有统计学意义(F=23.54,P<0.001);单月奖金比例随绩效考核比例增加而增加(F=256.73,P<0.001)。结论绩效考核与奖金分配方案体现了"多劳多得,优劳优得"的分配理念,具有一定可行性。     

南京市某区级医院的薪酬构成和绩效分配研究

新医改明确要求医院需提高绩效管理水平,着重突出"一线倾斜、多劳多得、优劳优得"的薪酬分配理念,这对公立医院的绩效管理提出了更高的要求.当前诸多医院的绩效考核还局限于职称和工龄的简单分配原则,没有充分体现多劳多得的分配原则,对于提高员工的工作积极性推动作用不大,不利于医院的长远发展.作者通过研究南京市某区级公立医院的薪酬...     

菏泽:医联体守护基层的“希望”

正作为山东省经济欠发达地区,菏泽市优质医疗资源总量相对不足,医疗机构自我"造血"能力不足,仅靠上级"输血"难以取得持续性效果。近年来,山东省借助医联体建设,集中省内优质医疗资源,针对区域精准发力,帮助菏泽市结合各县区特点综合运用内引外合、上挂下联等形式,推动优质医疗资源合理分配。合作共建业务骨干成为技术"助推器""以前有了大病就得跑到济南、北京,现在好了,省级专家就在咱家门口,     

医院绩效分配方案的改革与创新

绩效分配方案作为医院发展的引擎,对调动和激发医院职工的工作积极性,推动医院的发展起着举足轻重的作用。以"总量控制、按分计酬"为主线,通过对新、旧两种分配方法的对比分析,把工作量、经济效益以及综合绩效考评有机结合起来。破解了长期以来阻碍医院发展的瓶颈问题,形成了导向清晰、目标明确的绩效分配考评体系,较好地解决了"长期发展与短期增长、医院战略与个人绩效"之间的矛盾。有力地推进了医院的快速可持续发展。     

新形势下对综合医院住院部绩效工资考核的探讨

公立医院原有分配方法多是"成本核算、节余分配",过分强调了医院的市场属性而忽视了医院的公益职能。本文所探讨的在新形势下综合医院住院部绩效工资考核,将薪酬管理与绩效管理紧密联系,不与经济收入直接挂钩,以矫正医院和医务人员的"趋利"倾向,更好地体现公益属性,切实解决"看病难、看病贵"问题。     

滨州市新型农村合作医疗情况调查与研究

滨州市自2004年3月以来,已有5个县市(共有7个县市)加入省市新农合试点,通过新农合试点的实施,凸现了"群众得实惠、政府得信誉、医疗机构得发展"的"三赢"效应.     

关于医院分配制度改革的实践与思考

近年来,大庆市人民医院依据十六大提出的"劳动、资本、技术和管理"等生产要素制定分配的原则,以"淡化身份,强化岗位,突出绩效,加大激励,兼顾稳定,逐步过渡"的分配办法,大胆地进行了分配制度的改革,建立了以岗位系数为杠杆的岗位工资与以准成本核算及综合目标考评为基准的绩效工资相配套的分配制度,实现了职工、医院及社会三赢的目标.     

“四好”健康男人新标准

<正>最近,养生学家提出了中年男性符合健康条件的"四好"原则:吃得好、便得好、睡得好、反应好。吃得好、便得好:胃肠畅通无内疾"吃得好",即食欲好,胃肠激素、消化液分泌充分,则所进食的食物可能消化更完全。但是,"吃得好"并不是说"吃得快",相反,吃得快并不是一个好习惯。     

人事分配改革：强烈的需求 广阔的舞台

“人才是第一资源，得人才者得发展。”全省卫生工作会上．天瑞厅长在工作报告中对人事分配改革的精彩论述给与会者留下强烈的印象。人们普遍感到，这个卫生体制改革中的老、大、难问题，已到了非解决不可的     

上海市社区公共卫生服务资源配置公平性分析

目的:采用基尼(Gini)系数和泰尔(Theil)指数对上海市社区卫生服务资源配置公平性进行评价,为社区卫生服务资源的合理配置提供科学依据。方法:对全市19个区(县)所有社区卫生服务中心(站)进行疾病社区综合防治工作情况问卷调查。计算社区卫生服务团队、卫生技术人员和政府拨付经费按人口和面积配置的Gini系数和Theil指数,并对Theil指数进行分解。结果:上海市社区卫生服务团队、社区公共卫生技术人员和政府投入社区公共卫生经费在人口配置上的Gini系数分别为0.2734、0.3165和0.2261,处于公平的最佳状态,在地域分布上均超过0.4,处于警戒状态。Gini系数和Theil指数变动趋势一致。结论:上海市社区公共卫生服务资源配置公平性总体值得肯定,但地理公平性需引起重视。     

社区卫生工作人员付出—回报失衡与分级诊疗支持度的关系研究

目的：研究社区卫生服务中心工作人员对工作付出、回报及付出-回报失衡感受和对分级诊疗支持度之间的关系,并验证工作满意度在其中是否起到了中介作用。方法：选取北京市17家社区卫生服务中心,抽取1 057名工作人员进行问卷调查,使用付出-回报失衡量表测量工作付出、回报、超负荷和付出-回报失衡的情况,用工作满意度量表测量工作满意度,运用多元线性回归和Bootstrap检验对中介作用进行分析和验证。结果：社区卫生工作人员对工作付出与超负荷方面的感受和分级诊疗支持度不相关,在工作回报方面的感受与分级诊疗支持度呈显著正相关（P<0.001）,付出-回报失衡与分级诊疗支持度呈显著负相关（P<0.001）。工作满意度在回报与分级诊疗支持度、付出-回报失衡与分级诊疗支持度之间均存在显著的中介作用。结论：社区卫生工作人员的工作回报越高,或付出-回报失衡越低,其工作总体满意度就越高,对分级诊疗的支持度也会越高。     

从SARS相关知识知晓程度探索社区健康教育策略

目的探索在突发公共卫生事件中社区健康教育的策略。方法调查在SARS流行时,不同人群获取相关知识的情况和接受信息的途径。结果在相关知识的了解上,对SARS病原学、其传播途径和管理类别的掌握达80%左右,对使用何种消毒剂知晓率仅有57.3%,能够服从良好卫生习惯的比例仅有46.7%,特别是服务业仅有32%的人能够遵守预防SARS的行为习惯;小学以下文化程度与其他文化程度相比,对相关知识的知晓率最低。接受信息的途径以电视、社区宣传、报刊杂志为主,外来务工人员接受信息的途径比较分散。结论在SARS等公共卫生事件发生时,健康教育具有重要的作用,但也存在一些薄弱环节。文化程度低者、外来务工人员、服务行业人员需要加强健康教育的力度。     

社区医护人员工作满意度与职业紧张的关系

目的了解社区医护人员工作满意度状况并探讨其与职业紧张的关系,从而采取有效措施以提高社区医护人员的工作满意度。方法采用横断面调查方法,于2009年12月-2010年2月,随机抽取辽宁省30所社区卫生服务中心(站)的1 500名医护人员为对象进行自填式问卷调查。采用明尼苏达满意度问卷(MSQ)测量工作满意度,工作内容问卷(JCQ)和付出-回报失衡问卷(ERI-Q)测量职业紧张。应用分层回归分析社区医护人员工作满意度与职业紧张的关系。结果辽宁省社区医护人员的工作满意度平均得分为67.87。社会支持(β=0.35)、工作自主(β=0.27)、付出回报比值(β=-0.11)与工作满意度密切相关。结论应加强对社区医护人员工作满意度的关注,采取合理的保护措施以降低社区医护人员的职业紧张,提高其工作满意度。     

Epidemiological and socio-demographic profile of primary care workers in the South and Northeast of Brazil

In order to describe the profile of primary health care teams in 41 municipalities with more than 100 thousand inhabitants each, a total of 4,749 health workers in two States from the South (1,730) and five from the Northeast (3,019) of Brazil were included from a sample of traditional primary care units and the Family Health Program (FHP). After providing informed consent, the health workers answered a self-applied questionnaire with demographic, work-related, and their own health-related data. The principal differences between the two models involved the structuring of the teams, with the FHP including more community health agents, more women, more young workers, fewer hired on the basis of formal admissions exams, more with a single job, more precarious employment arrangements, less employment satisfaction, less time on the job, larger workloads, greater specialization in the area, and better pay. The FHP also showed worse self-perceived health and more medical appointments. Management efforts are needed to support these workers, who form the basis of the health system and are key protagonists in the development and consolidation of primary care.     

Factors Influencing the Turnover Intention of Chinese Community Health Service Workers Based on the Investigation Results of Five Provinces

After the implementation of the new health reform, the Chinese government paid increasing attention to developing its community health service (CHS). The focus is mainly on cultivating community general medical practitioners but paying less attention to the working status and occupational demands of in-service CHS workers. CHS requires a stable team that can provide good service to community residents. At present, the demission rate of CHS workers is high. Studying how to increase the stability of CHS workers is noteworthy. The goal of this study is to ascertain the key factors that influence the CHS worker turnover intention to increase their work satisfaction and stability. A total of 100 CHS organizations were sampled randomly in 10 cities from 5 Chinese provinces for this study. All CHS workers from these organizations took a questionnaire survey. In total, 3,212 valid answer sheets were collected. Pearson Chi square test and Binary logistic regression were used to analyze the related influencing factors that result in CHS worker turnover intention. A total of 38.7 % of those who accomplished the questionnaire intended to quit. The influencing factors that result in CHS worker turnover intention are (1) socio-demographic factors such as age, post of duty, professional title, and working seniority, and (2) other work-related factors such as pay packets, learning and training opportunities, promotion and personal development space, and working stress. CHS workers were less satisfied with the balance between payment and work quantity, promotion opportunity, and working conditions. Based on the results, the government should pay more attention to the various demands of CHS workers in service, especially by increasing their income, providing more learning and training opportunities, and increasing the degree of their work satisfaction to avoid turnover intention and ensure the stability of the CHS workforce.     

Effectiveness of community health financing in meeting the cost of illness

How to finance and provide health care for the more than 1.3 billion rural poor and informal sector workers in low- and middle-income countries is one of the greatest challenges facing the international development community. This article presents the main findings from an extensive survey of the literature of community financing arrangements, and selected experiences from the Asia and Africa regions. Most community financing schemes have evolved in the context of severe economic constraints, political instability, and lack of good governance. Micro-level household data analysis indicates that community financing improves access by rural and informal sector workers to needed heath care and provides them with some financial protection against the cost of illness. Macro-level cross-country analysis gives empirical support to the hypothesis that risk-sharing in health financing matters in terms of its impact on both the level and distribution of health, financial fairness and responsiveness indicators. The background research done for this article points to five key policies available to governments to improve the effectiveness and sustainability of existing community financing schemes. This includes: (a) increased and well-targeted subsidies to pay for the premiums of low-income populations; (b) insurance to protect against expenditure fluctuations and re-insurance to enlarge the effective size of small risk pools; (c) effective prevention and case management techniques to limit expenditure fluctuations; (d) technical support to strengthen the management capacity of local schemes; and (e) establishment and strengthening of links with the formal financing and provider networks.     

北京市某功能社区科技工作者心理健康状况调查

目的 了解北京市功能社区内科技工作者心理健康现状,为针对性的在功能社区中开展科技工作者心理健康干预提供参考.方法 采用简单随机抽样,抽取某功能社区年龄在18～59岁之间的在岗科技工作者385名,运用症状自评量表（SCL-90）及自编基本情况调查表进行调查分析.结果 该功能社区中科技工作者心理障碍阳性检出率为24.54％,科技工作者的总体心理健康水平均高于全国常模.其中,女性、18～28岁组、硕士学历的科技工作者更容易出现心理健康问题.结论 在功能社区中设立心理咨询中心,各科技工作机构应重点关注女性、刚步入工作岗位的科技工作者,以及硕士学历的科技工作者的心理健康状况.     

The preventive-curative conflict in primary health care

Approximately 80% of the rural population in developing countries do not have access to appropriate curative care. The primary health care (PHC) approach emphasizes promotive and preventive services. Yet most people in developing countries consider curative care to be more important. Thus, PHC should include curative and rehabilitative care along with preventive and promotive care. The conflict between preventive and curative care is apparent at the community level, among health workers from all levels of the health system, and among policy makers. Community members are sometimes willing to pay for curative services but not preventive services. Further, they believe that they already know enough to prevent illness. Community health workers (CHWs), the mainstays of most PHC projects are trained in preventive efforts, but this hinders their effectiveness, since the community expects curative care. Besides, 66% of villagers' health problems require curative care. Further, CHWs are isolated from health professionals, adding to their inability to effect positive change. Health professionals are often unable to set up a relationship of trust with the community, largely due to their urban-based medical education. They tend not to explain treatment to patients or to simplify explanations in a condescending manner. They also mystify diseases, preventing people from understanding their own bodies and managing their illnesses. National governments often misinterpret national health policies promoting PHC and implement them from a top-down approach rather than from the bottom-up PHC-advocated approach. Nongovernmental organizations (NGOs) and international agencies also interpret PHC in different ways. Still, strong partnerships between government, NGOs, private sector, and international agencies are needed for effective implementation of PHC. Yet, many countries continue to have complex hierarchical social structures, inequitable distribution, and inadequate resources, making it difficult to implement effective PHC.     

Changes in health habits of female shift workers

This paper examines the effects of shift work on the lifestyles of female factory workers. As an indicator of healthy lifestyle habits, we used a scoring system (referred to below as the 'health score') based on Lester Breslow's health habits. The 'health score' of the women was higher than that of the men, but the shift workers' score was lower than that of the non-shift workers (p<0.01). In addition, the score of workers who had changed from non-shift work to double-shift work was remarkably low (p<0.01). These results suggest that, while the female shift workers manage to maintain relatively healthy lifestyles in comparison with the males, they have more difficulty maintaining these habits than do female workers who do not perform shift work. It can be concluded that, in addition to heightening women's consciousness of their own health, surrounding entities such as the work environment, the home, and the community in general need to pay due care to Japan's female shift workers.