社区卫生服务机构实施收支两条线管理的现状及对策

经过多年的探索,社区卫生服务机构实行收支两条线管理的成效显著。社区卫生服务机构的公共卫生服务得到有效落实,无论是社区医务人员还是社区居民满意度都有较大提高。然而,社区卫生服务机构实行收支两条线管理也遇到了许多问题。文章通过对社区卫生服务机构实施收支两条线管理的现状、困难进行分析,就存在的新问题提出合理性建议与对策,总结实施收支两条线管理的必要性,在新医改攻坚阶段从而更好地完善政府投入、收支运行、考核分配等管理体制与运行机制,进一步保障社区卫生服务机构的正常运行,充分发挥收支两条线管理在社区卫生综合改革中的核心作用。     

北京社区卫生服务机构员工对收支两条线管理的认知评价

[目的]了解北京社区卫生服务机构员工对收支两条线管理的认知评价情况.[方法]采取问卷调查的方法,调查北京社区卫生服务机构员工对收支两条线管理的认知评价情况,进行相应的统计学分析.[结果]201名社区卫生服务工作人员中78.1%认为在社区卫生服务机构实施收支两条线可以提高员工的工作积极性,83.1%希望实行收支两条线;所在机构已实施收支两条线管理的人员对该改革措施的反馈结果不乐观.[结论]北京市社区卫生工作人员对收支两条线管理的实施表示支持,实施意愿较高,但是应对配套的绩效考核评价体系进行深入的研究和论证,从而有效地提高社区医务人员的工作积极性.     

社区卫生服务收支两条线管理可持续发展的政策建议

目的 总结社区卫生服务中心实行综合改革试点后在收支两条线管理方面取得的成效,进一步完善收支两条线管理评价方法.方法 对上海市首批试点某区进行社区卫生服务收支两条线管理动态评价和效果分析.结果 某区社区卫生服务机构年度总收入下降了2.24%,其中检查收入和手术收入下降最多.全科人员及预防保健人员收入增加较多,工作业绩也有较明显的增长.社区居民、卫生行政人员及卫生服务人员对到中心看病是否方便、就医环境、医务人员服务内容及解释和交流情况、服务技术水平等满意度调查结果,差异无统计学意义;但对医务人员服务态度方面,卫生行政人员不满意(χ2=9.340,P=0.009).结论 上海市某区社区卫生服务收支两条线管理已取得较好成绩.建议进一步完善效果评价体系和评价标准,保证其科学性和有效性.     

典型地区社区卫生服务机构收支两条线管理模式的比较分析

通过分析典型地区社区卫生服务机构收支两条线管理模式,其共同特点是实行全额预算管理,以区财政为主实行多级财政筹资,收支两条线管理实施过程中收入和支出的内容基本相同;不同点包括收支两条线管理的方式、社区卫生服务机构总收入中财政投入标准和支出管理等三个方面的差异。通过分析不同收支两条线管理模式的优缺点．提出社区卫生服务机构实施收支两条线管理并没有绝对的最优和最差做法,各地在实践中,既要分析不同模式的优缺点,也要结合本地实际,总结已有的经验和教训,以便顺利开展社区卫生服务机构收支两条线管理试点。     

社区卫生服务中心收支两条线试点工作的做法和体会

为了有效地维护社区卫生服务的公益性质,实现免费提供公共卫生服务、低成本提供基本医疗服务,切实减轻群众医药费用负担,确保经济发展的成果惠及普通百姓的目标,南京市秦淮区自2007年4月正式启动了“社区卫生服务运行机制改革”,并以对社区卫生服务中心实行“收支两条线”管理为改革的突破口,走出了一条符合国家医改方向,社区居民拥护,得到省市政府部门充分认可的改革之路。     

社区卫生服务机构实行收支两条线管理的利益相关者分析

利用利益相关者理论分析社区卫生服务机构实行收支两条线管理的各方利益者.其中主要利益相关者是社区居民、社区卫生服务机构及其医务人员,次要利益相关者是地方政府和卫生主管部门,外部利益相关者是医保部门和药商.通过对各方利益者的深入分析,提出了政策实施中应注意的关键问题.     

社区卫生服务机构收支两条线管理的运作模式分析

通过分析并评价目前全国各地社区卫生服务机构收支两条线管理的主要运作模式,总结实行社区卫生服务机构收支两条线管理所需的前提条件.提出各地应当在机制、体制基本理顺,各项制度环境基本建成,社区卫生服务整体发展良好的情况下开展试点,切忌盲目推行.     

南京三级医院实行“药房托管”

近日，从南京市卫生工作会议上获悉，南京社区医院今年将全面实行“收支两条线预算管理、基本用药零差率销售”运行机制改革，“做到社区基本医疗用药不赚老百姓一分钱”。社区卫生服务机构所有收入全部上缴财政账户，医务人员的收入根据综合考核予以发放。统一基本用药目录，城区320种基本药物、农村160种基本药物实行零差率销售。     

社区卫生服务机构人员对实施"收支两条线"改革满意程度的分析

目的了解杭州市社区卫生服务机构负责人和医务人员对实施"收支两条线"的满意程度.方法采用调查问卷的形式对社区卫生服务机构负责人和医务人员进行调查分析.结果机构负责人和医务人员对实施"收支两条线"总体满意程度分别为58.3%和39.8%.结论社区卫生服务机构人员对实施"收支两条线"总体上是满意的,但还需进一步完善"收支两条线"制度.     

农村社区卫生服务机构收支两条线管理实施效果调查分析

目的探讨农村社区卫生服务机构实施收支两条线管理后的运行效果。方法对某大型城市位于农村的8家社区卫生服务中心进行回顾性调查,对相关人员进行访谈,并对收集的相关数据进行统计学处理。结果不同区、县收支两条线管理的模式不尽相同,实施收支两条线后,农村社区卫生服务机构的出院人次和手术例数下降,门诊人次和公共卫生服务量(除孕产妇管理和计划生育咨询)增加。结论落实社区卫生服务机构支出的预算管理,加强绩效考核,将有助于发挥社区医务人员的积极性,提高社区卫生服务机构的服务量和服务质量。     

Survey of ethylenethiourea (ETU) in ethylenebis(dithiocarbamate) (EBDC) fungicides

Ethylenethiourea (ETU) has been recognized as a compound with adverse toxicological properties. It may occur in ethylenebis(dithiocarbamate) (EBDC) fungicides as a by-product and/or a degradation product. Restrictions have been issued by the Italian Health Authority to keep the level of ETU in EBDC formulations under 0.5% (on an EBDC technical product basis). A survey was carried out on 85 samples of commercial formulations from the Italian market to verify compliance with the above limitation. ETU was extracted by methanol and determined by gas chromatography with a flame ionization detector. Three of the 85 samples (3.5%) exceeded the limit of 0.5% established by the Italian legislation for ETU.     

Diagnostic image (5) (Ileum pathology)

In a 28-year-old woman Crohn's disease was diagnosed. She had drug treatment but the situation deteriorated and ileocoecal resection was carried out. In the surgical specimen the diagnosis was confirmed.     

Sorption of Phosphate and Cr(VI) by Fe(III) and Cr(III) Hydroxides

Understanding the chemical behavior and interactions of Cr(VI) (e.g., HCrO₄ ⁻) and other anions, such as orthophosphate (P) with insoluble metal hydroxides (i.e., Cr[III] and Fe[III]) in disposal landfills or in chromite ore processing residue (CORP)–enriched soil is very important in predicting the movement and the fate of Cr(VI). This study evaluates the sorption behavior of P and Cr(VI) by Fe(III) (i.e., ferrihydrite), Cr(III) (i.e., Cr[OH]₃), and coprecipitated Fe(III)/Cr(III) hydroxides. These metal hydroxide sorbents were synthesized, and sorption of P and Cr(VI) were conducted at different pH using a batch technology. Our results show that P and Cr(VI) sorption by metal hydroxides decreased with increasing suspension pH. Greater decrease in P sorption was observed when Cr(III) was present in the structures of hydroxides. Following the sorption of low concentration of P (i.e., 0.5 mM), the sorption of subsequently added Cr(VI) by hydroxides was less influenced. However, Cr(VI) sorption was greatly inhibited when high concentration of P (i.e., 10 mM) prereacted with hydroxides, particularly in Fe(III) hydroxide system. Results also indicated that high concentration of Cr(VI) (10 mM) could dissolve Cr(III) hydroxide at pH 3 and reprecipitate as an amorphous form of Cr(VI) and Cr(III) compound at pH about 6.5. Although coprecipitation of Cr(VI) with Cr(III) can inhibit Cr(VI) movement through soil profiles, the inhibition seems to be low due to the gradual release of Cr(VI) with increasing pH. Received: 16 April 2002/Accepted: 29 October 2002     

Crusted (Norwegian) scabies in Dakar (Senegal)

Between January 1993 and June 1997, 30 patients with crusted scabies were seen at the dermatological clinic in Dakar (Senegal). Seventeen of these patients were male and 13 were female. Six were children aged 5 to 15 years and 24 were adults aged 18 to 70 years. Diagnosis of crusted scabies was straightforward because this condition, which was rare in Dakar before 1990, has become much more common and is now familiar to Senegalese dermatologists. The infection presented as an extensive scaly or crusted eruption with symmetrical lesions affecting the hands, feet, knees, elbows and ears in particular. Scalp involvement was reported in 25 patients. Erythrodermia was present in 4 cases and pachyonychia in 4 cases. Twenty-seven of the 30 patients had moderate or severe pruritus, whereas an absence of pruritus is regarded as a classical characteristic of crusted scabies. Diagnosis was readily confirmed by examination of hyperkeratotic material under the microscope: numerous mites and eggs were present. The two most common etiological factors were auto-immune diseases (6 cases, 4 of whom were receiving no steroid or other immunosuppressive treatment at the time of onset of crusted scabies) and malnutrition (5 of the 6 children in the study). The other associated conditions identified were: physical debilitation (4 cases), HIV infection (3), mental disability-Down's syndrome (3) and long term use of topical steroids for artificial depigmentation (2). Two patients were immunocompetent and 5 patients died shortly after diagnosis, before any underlying conditions could be identified. Seven patients were cured with benzyl benzoate. Seven others, all adults, received a single oral dose of ivermectin (200 mg/kg) and topical kerolytic drugs. Ivermectin was ineffective in 1 case, and an improvement was observed in another case, although a complete cure was achieved only after a second dose. The other patients were all cured and showed no signs of scabies one month after ivermectin treatment. A recurrence was observed in 3 patients a few months later however, suggesting that these patients were reinfected. No side effects were reported in any of the patients treated with ivermectin.