谈医疗机构"医药分开核算、分别管理"

医疗机构实行“医药分开核算、分别管理”,旨在规范医疗行为,促进医疗机构收入结构的调整,优化医疗机构补偿机制,控制医院医药费用过快增长,降低药品收入在医院收入中的比重,促使医疗机构为群众提供质优、价廉的医疗服务。 医疗机构实行“医药分开核算”就是按照新的《医院会计制度》(以下简称《制度》),对医疗成本和药品成本分别核算。医疗服务和药品经销各项直接费用,要分别列入医疗支出和药品支出。医疗机构的管理费用,要按《制度》要求合理分摊到医疗成本和药品成本。要依照有关规定严格控制费用支出?严禁乱摊费用、扩大成本。 医疗机构要实行医药分别管理,笔者认为应实行“核定收     

镇江市医疗机构实行药品分别管理的实践

镇江是国务院进行职工医疗保险制度改革的试点城市 ,根据国家体改委等四部门联合下发的《关于职工医疗保险制度改革的试点意见》(以下简称《意见》)提出的 :“要在调整医疗服务价格的基础上 ,逐步实行医疗服务和销售药品分开核算 ,允许病人持处方到医院外购药”。镇江市从１９９５年起就对医院药品收入实行分开核算、分别管理。实践一、医药实行分开核算、分别管理１９９５年底镇江市出台的《医疗机构医疗服务和药品销售收入分开核算、分别管理的暂行办法》 (以下简称《办法》)规定 ,医疗机构要在遏制医疗费用过快增长的前提下 ,优化收入结…     

对医药分管模式的探讨

《关于城镇医药卫生体制改革的指导意见》（以下简称《指导意见》）指出：医院实行医药分开核算、分别管理,药品实行收支两条线,药品收支结余按比例足额上缴,合理返还,用于弥补医疗成本以及社区卫生服务、预防保健等其他卫生事业。为认真贯彻落实此精神,现拟就医药分管模式进行如下探讨。 实行医药分开核算、分别管理的目的是为了切断医疗机构与药品营销之间的直接经济利益联系、以控制医药费用的过快增长。医和药是左右手的关系,医院药房的功能不仅仅是卖药,更重要的是指导临床用药。笔者认为医药分开核算、分别管理的核心是管理模…     

实行"医药分开核算、分别管理"应解决的几个问题

实行“医药分开核算、分别管理”是《中共中央、国务院关于卫生改革与发展的决定》的一项主要内容。日前,由国务院体改办等八部门共同制定的《关于城镇医药卫生体制改革的指导意见》,对这一问题在现阶段的实施又作了进一步的规定:“实行医药分开核算、分别管理。……可先对医院药品收入实际收支两条线管理,药品收支结余全部上缴卫生行政部门,纳入财政专户管理,合理返还,……。”那么,在现阶段怎样才能真正落实“医药分开核算、分别管理”,达到降低患者负担的目的呢?笔者认为首先应解决好以下几个问题: 1 解放思想,更新观念,增强医药卫生体制改革的紧迫感 1.1 在当前的医院业务收入中,药品收入所占比例过大     

湖南:走"以医养医"之路

在国务院体改办等部门《关于城镇医药卫生体制改革指导意见》中,引起众多医院震动性较大的一条是实行医药分开核算,分别管理,对医疗机构的药品收入实行“收支两条线”管理,切断医疗机构和药品营销之间的直接经济联系,从制度上解决医疗机构“以药养医”的弊病。这意味着医院将不再拥有药房收入的支配权。医院今后靠什么来养活自己呢？据我们对湖南省现在的省直医院情况的了解,约有２０％的医院束手无策,依赖政府的政策安排;６０％的医院摸着石头过河,边走边看;２０％的医院主动出击,摆脱“以药养医”,走“以医养医”之路。 湖南…     

医药卫生体制改革进入攻坚阶段的几个问题

《关于城镇医药隆重体制改革的指导意见》的颁布,表明卫生改革进入攻坚阶段。当前卫生发展与国民经济的发展不相适应,必须政府的宏观调控。《指导意见》针对事关卫生改革成败的体制、体制、法制问题提出了实行三个“分”的对策,即政事要分开、医疗机构要分类管理、医药要分开核算分别管理,其中政事分开要求卫生行政部门要转变职能,实行全行业管理,并通过建立医疗卫生要素准入制度,来管理医疗卫生机构。     

加强对非营利性医疗机构财务监督管理的探讨

国务院办公厅批转八部委《关于城镇医药卫生体制改革的指导意见》(以下简称《指导意见》) ,指出 :“卫生、财政等部门要加强对非营利性医疗机构的财务监督管理”。同时要求 :“加强医疗机构的经济管理 ,进行成本核算 ,有效利用人力、物力、财力等资源 ,提高效率、降低成本”。这对各级各类卫生事业单位尤其是各级医疗机构的财务管理提出了更高的要求 ;同时 ,随着《指导意见》的落实 ,医疗机构也面临着深层次的改革 :医疗机构的分类管理 ;内部运行机制的转变 ;医药分开核算 ,分别管理的实行及财政补助范围和方式的规范 ;医疗服务价格的调整等…     

对实施"医药分开核算分别管理"制度几个问题的思考

《关于城镇医药卫生体制改革的指导意见》提出了对医院药品收入进行“医药分开核算分别管理”制度,这个制度的实施对于有效控制医药费用的上涨会产生良好的效果。但如何把“医药分开核算分别管理”作为控制医药费用的惟一手段,不可能达到预期效果,甚至会造成药品支出的失控,作者从药品费用上涨的原因、控制药品费用环节以及实施“医药分开核算分别管理”制度应注意的问题等几个方面进行了思考,提出政府应从宏观上采取措施对药厂     

贯彻医药分开核算分别管理的实践与思考

由国务院八部委联合下发的《关于城镇医药卫生体制改革的指导意见》指出“必须切断医疗机构和药品营销之间的直接经济利益联系 ,逐步规范财政补助方式和调整医疗服务价格的基础上 ,把医院的门诊药房改为药品零售企业 ,独立核算”。实行医药分开核算分别管理是解决当前存在的“以药养医”现象的主要政策措施。本文拟对上海市某区控制药品费用现状和实施医药分开核算分别管理的可行性作一初步研究分析 ,提出相应的对策和建议 ,供有关领导部门决策参考。1　材料与方法对本市某区 5所有代表性的一、二、三级医院进行回顾性调查。收集 1998年、19…     

医药分开核算、分别管理应注意的三个问题

国务院《关于城镇医药卫生体制改革的指导意见》(以下简称《指导意见》)中指出,“实行医药分开核算、分别管理。”笔者认真学习后,认为各地在贯彻执行这一政策时,要注意以下三个问题。一、医药分业宜先在社会医疗机构和个体诊所中进行１．早有政策规定国家药品监督管理局１９９９年６月１５日发布、同年８月１日施行的《药品流通监督管理办法》(暂行)第二十七条指出:“城镇中的个体行医人员和个体诊所不得设置药房,不得从事药品购销活动。”由于多种原因这一规定没有落实。各级卫生行政部门要利用贯彻《指导意见》的机遇,落实药监局的这一规…     

Beyond "medical tourism": Canadian companies marketing medical travel

ABSTRACT: BACKGROUND: Despite having access to medically necessary care available through publicly funded provincial health care systems, some Canadians travel for treatment provided at international medical facilities as well as for-profit clinics found in several Canadian provinces. Canadians travel abroad for orthopaedic surgery, bariatric surgery, ophthalmologic surgery, stem cell injections, "Liberation therapy" for multiple sclerosis, and additional interventions. Both responding to public interest in medical travel and playing an important part in promoting the notion of a global marketplace for health services, many Canadian companies market medical travel. METHODS: Research began with the goal of locating all medical tourism companies based in Canada. Various strategies were used to find such businesses. During the search process it became apparent that many Canadian business promoting medical travel are not medical tourism companies. To the contrary, numerous types of businesses promote medical travel. Once businesses promoting medical travel were identified, content analysis was used to extract information from company websites. Company websites were analyzed to establish: 1) where in Canada these businesses are located; 2) the destination countries and health care facilities that they market; 3) the medical procedures they promote; 4) core marketing messages; and 5) whether businesses market air travel, hotel accommodations, and holiday tours in addition to medical procedures. RESULTS: Searches conducted from 2006 to 2011 resulted in identification of thirty-five Canadian businesses currently marketing various kinds of medical travel. The research project began with what seemed to be the straightforward goal of establishing how many medical tourism companies are based in Canada. Refinement of categories resulted in the identification of eighteen businesses fitting the category of what most researchers would identify as medical tourism companies. Seven other businesses market regional, cross-border health services available in the United States and intranational travel to clinics in Canada. In contrast to medical tourism companies, they do not market holiday tours in addition to medical care. Two companies occupy a narrow market niche and promote testing for CCSVI and "Liberation therapy" for multiple sclerosis. Three additional companies offer bariatric surgery and cosmetic surgery at facilities in Mexico. Four businesses offer health insurance products intended to cover the cost of obtaining privately financed health care in the U.S. These businesses also help their clients arrange treatment beyond Canada's borders. Finally, one medical travel company based in Canada markets health services primarily to U.S. citizens. CONCLUSIONS: This article uses content analysis of websites of Canadian companies marketing medical travel to provide insight into Canada's medical travel industry. The article reveals a complex marketplace with different types of companies taking distinct approaches to marketing medical travel.     

医疗红包现象产生的原因及对策 --论医疗红包及其治理(下)

在系统论述了医疗红包现象产生和蔓延的经济、文化和管理背景的基础上，提出了治理医疗红包的对策：加强党的领导，紧紧依靠群众，实行综合治理，标本兼治，突出重点，持之以恒。     

Community medicine: the "first-born" of a marriage between medical education and medical care

In Southern Israel, rapid development and industrialization have generated strains affecting both the population (ca. 0.5 million immigrants and ca. 50,000 Bedouin) and the medical care agencies (of the General Labour Federation and other Sick funds, the Health and other Ministries, etc.). In Beer-Sheva, the Center of Health Sciences (CHS) of the Ben-Gurion University of the Negev (BGUN) is the scene of a concerted effort to change the orientation of health care. The direction of change is away from the impersonal (the hospital and the disease) and towards that demanded by the public (the community and the person). It is being accomplished by fundamentally changing the education of health personnel. Change is being implemented and mediated by a coordinating consortium of in-region and BGUN care and/or welfare agencies, that plans and evaluates the process and progress of change for which each agency is responsible. Infrastructural innovation, somewhat hampered by the inertias of tradition, consists of making the university hospital effectively serve the regional network of hospital-affiliated, community-oriented primary care clinics. Curricular innovation, enthusiastically accepted and flourishing, uses the concept of "the natural history of disease" in basic-science and clinical teaching. Teaching takes place not only in the wards, but also in outpatient and primary care clinics, and in the facilities for occupational health, rehabilitation and public health.     

围绕"医学教育中国标准",积极推进医学教育改革

围绕我国的<本科医学教育标准-临床医学专业>,以为地市级及以下卫生医疗机构培养应用型人才为目标,加强教师队伍建设,坚持医学教育实施精英教育的理念,优化课程体系,凸现临床能力培养这一主线,注重学生创新和终身学习的能力培养,积极推进我校的医学教育改革.     

The "new" medical malpractice crisis--part 1

It is important to put the current medical malpractice crisis into the historical context of the past several decades. Doing so provides an important perspective from which to understand the current iteration. One may reasonably conclude that the present medical malpractice situation is only the latest outbreak of a continuing, chronic condition, rather than a distinct, unusual event. In this regard, it is analogous to a chronic disease that occasionally flares up. Chronicity suggests the presence of major underlying problems, which may be linked to insurance carriers' business cycles as much as reflecting increases in either medical malpractice or the numbers and value of claims. It is useful to bear in mind that the fact of a claim may or may not indicate actual medical malpractice, and increased claims could well correlate more closely with patients' disgruntlement with the medical delivery system, access to it, and the way they were treated by staff than with significant injuries for which compensation should be paid. Regulatory and public policy efforts to date have only affected the problem of medical malpractice at the margin. Apparently, the core of the problem has not been addressed; in fact, it seems as yet to be unidentified. Solutions that focus on the economic dimensions only address the symptoms-claims for medical malpractice-and apparently have done nothing to correct the root cause(s). Part 2 of this two-part series considers and analyzes the current medical malpractice insurance crisis. Its evolution and analysis of specific aspects may provide guidance in understanding how to predict its future course. More important, the analysis will suggest guidance as to how organizations may reduce the potential for the problem and protect themselves from the negative aspects, should it occur.