潍坊市普及基本医疗卫生制度的基本经验

潍坊市在开展普及基本医疗卫生制度实验性研究的过程中,经过精心设计,不断探索,在思维转变、部门合作和体制创新等方面取得了一些经验。     

潍坊市普及基本医疗卫生制度实验研究实施效果评价概要

文章介绍了潍坊市普及基本医疗卫生制度实验研究效果评价指标体系,同时,依据该指标体系,从政策支持和社会动员、可得性建设、可及性建设、卫生服务利用和质量效率以及健康状况和满意度等6个方面,对实验研究的实施效果进行概括和总结。     

基本医疗卫生制度对居民基层卫生机构门诊服务利用的影响

目的:分析基本医疗卫生制度实施对居民基层卫生机构门诊服务利用的影响。方法:实验研究前后,分别按照整群随机抽样方法抽取部分居民,利用统一调查表进行入户面对面访谈,获取居民就诊流向、门诊服务利用及费用等资料。结果:与对照县和基线调查结果相比较,项目县居民基层卫生机构就诊比例提高,应就诊未就诊率略有下降,门诊次均费用下降,个人自付比例降低。结论:基本医疗卫生制度的实施促进了居民对基层门诊服务的利用,居民就医可得性和可及性提高。     

潍坊市普及基本医疗卫生制度实验研究目标分析

潍坊市于2008年开展了基本医疗卫生制度实验研究,文章从普及基本医疗卫生制度目标体系制订的目的和意义的角度出发,结合潍坊市卫生经济发展情况,通过文献检索和专家咨询的方法,从可得性和可及性两个方面确定了"小病社区低收费、大病住院有保险和公共卫生政府管"的目标体系,为下一步基本医疗卫生制度的建立奠定基础。     

潍坊市普及基本医疗卫生制度支付方式改革实践

文章介绍了潍坊市普及基本医疗卫生制度实验研究支付方式改革的实践及经验。实验研究针对不同的卫生服务内容及其经济学特性,进行了相关的支付方式改革探索：门诊服务由按服务项目支付转变为政府按人头支付和按诊次支付;大病及住院服务则进行了单病种的按人头付费和总额预付制的探索;公共卫生服务则由政府以＂购买服务＂的形式实行按人头支付。     

基本医疗卫生制度基础构架建设的实践探索

将"四梁八柱"归纳为"四大体系、四大机制、四大支持",重点介绍了潍坊市普及基本医疗卫生制度实验研究过程中"四梁八柱"建设的实践做法和经验。四大体系即公共卫生、医疗服务、医疗保障和药品保障供应体系;四大机制包括筹资机制、合理施治机制、医疗卫生机构主动从事防保机制和投诉处置机制;四大支持包括信息技术支持、科技与人才支持、组织动员支持和监督管理支持。     

基本医疗卫生制度作用下的城乡居民就医行为

卫生体系和卫生政策直接或间接地影响患者的就医行为。基本医疗卫生制度包括基本医疗保障制度、基本药物制度、基本医疗卫生服务体系、基本公共卫生服务体系,旨在通过提供基本医疗卫生服务,缓解"看病难、看病贵"问题,保证居民合理就医。本文将回顾卫生制度和就医行为关系的理论和实证,综述每一项基本医疗卫生制度对城乡居民就医行为的影响,包括影响程度、路径方式等,比较就医行为对不同政策的敏感程度,并指出各项制度调整的方向。     

建立乡镇卫生院卫生技术人员在职培训制度的思考

提出了建立健全乡镇卫生院卫生技术人员在职培训制度的基本框架，构建了贯彻执行在职培训制度的基本机制。对乡镇卫生技术人员在职培训制度的建立对乡镇卫生院工作可能产生的潜在作用和深层次影响进行了讨论。     

医疗卫生人员的高血压知识、态度和行为

高血压不仅是发达国家 ,而且是发展中国家的主要公共健康问题。其危害不只是因为其本身可发展为高血压危象危及生命 ,还在于它是心肌梗死、脑卒中的主要危险因素。积极防治高血压是预防和减少心血管病 (ＣＶＤ)的关键性措施。成功的关键是政府部门强有力的领导、医务人员的尽职尽责和广大群众的积极参与。其中医务人员的作用至关重要 ,是高血压防治的主要力量 ,其对高血压的知识、态度和行为 (ＫＡＢ)将直接影响高血压的控制。医务人员高血压ＫＡＢ现状基于许多大型临床试验的结果 ,对高血压有了许多新的认识。在过去通常认为舒张压的危害要…     

基本药物制度对基层医疗卫生机构合理用药的影响

选取安徽、浙江、山东和宁夏的10个区县,对比分析基层医疗卫生机构在基本药物制度实施前后单处方药品种数、单处方基本药物种数、单处方抗菌药品种数、含抗生素的处方比例、含激素的处方比例和含注射剂的处方比例等指标,探讨实施基本药物制度对基层医疗卫生机构合理用药的影响。     

分级诊疗实施后对医务人员的影响及其认知状况调查

目的:了解分级诊疗制度实施后对试点地区各级医疗机构医务人员的影响,以及医务人员对分级诊疗的认知状况和影响因素。方法:采用多阶段随机抽样方法,对15个试点地区各级医疗机构的435名医务人员进行问卷调查。结果:制度实施后,不同级别医疗机构医务人员在月总收入、绩效工资占比、工作负担和医患关系方面存在差异;各级医疗机构医务人员对分级诊疗的总体认知率达81.4%,其中三级医院依次高于乡镇卫生院、社区卫生服务中心和二级医院;不同科室类别、职称级别、绩效工资占比和薪酬变化的医务人员对分级诊疗认知状况有差异。结论:要进一步发挥医务人员对分级诊疗的关键作用,提升基层服务能力的同时,加大对二级医院的关注,改革薪酬制度,调动医疗机构和医务人员的积极性,促进分级诊疗制度更好地发展。     

The impact of community risks and resources on adolescent risky behavior and health care expenditures

PurposeTo examine a nested model that predicts adolescent risky behavior, health care use, and health care expenditures from individual characteristics, such as age and gender, and community characteristics such as social capital and community-level risky behavior rates.MethodsClaims and encounter data were used to classify adolescents enrolled in Florida’s Healthy Kids Program into two groups: those who engaged in risky behavior (ARB) and those who did not (NRB). Hierarchical linear modeling techniques were used to predict the odds of risky behavior, the odds of health care use, and health care expenditures based on individual and community characteristics.ResultsARB consumed significantly more health care services than NRB, and their higher use and charges were attributable not only to individual level factors (i.e., age, gender, presence of special health care need, metropolitan residence status), but also to community level factors (i.e., social capital, risky behavior rates, violence, and ethnic/racial composition) as well. In particular, community investment in social capital predicted lower levels of risky behavior as well as lower health care expenditures.ConclusionsThis information is important in terms of policy efforts at providing health care for this vulnerable group of individuals, as well as in developing prevention and intervention programs that can be delivered through the health care system and via links to community supports.     

The illusion of control and the importance of community in health care organizations

The complexity of our health care environment and organizations requires a management style that moves beyond control to empowerment. Even though this complexity minimizes our ability to control events, many organizations are still preoccupied with the illusion of control. This restrains the performance of our health care organizations. Some of the contributing factors supporting this illusion are bureaucracy, scientific methodology, individualism, and our confusion of management with leadership. The concept of "community" is discussed from an organizational perspective. It is suggested that we can improve the performance of our organizations by rediscovering the values of community.     

Depression care management: impact of implementation on health system costs

This study examined the mental health care costs associated with implementation of a collaborative care management (CCM) of treatment for depression in primary care. A retrospective review of all costs was performed over a 2-year period associated with providing care to adult patients at clinical sites with CCM versus those with usual care, comparing total and mental health per member per month (PMPM) costs for 2008 and 2009 (patient population = 103,000). The mental health-PMPM costs as a percentage of total health care costs at the clinic without CCM were 4.65% in 2008 and 4.5% in 2009 (p = .085). In the clinics with CCM, there was a significant difference between the 2 years with a decrease noted in 2009 of 4.91% compared with 4.36% in 2008 (p < .0001). This study demonstrated that, on a population basis with the implementation of CCM, the metric of mental health-PMPM (using the actual costs of delivering care) suggested that an increased short-term cost of care is not always realized. Collaborative care management treatment for depression may be a more cost-efficient method of care for the population as a whole, even in the short term.     

The changing world of HIV care: The impact on health professionals

Recent advances in treatment have improved the health of many people living with HIV/AIDS. The research described in this paper shows that the changing context of care is also impacting significantly on people who provide services. In this paper, we explore both perspectives by comparing recent service provider data with that derived from research involving people living with HIV/AIDS. We explore four themes: (1) hope and optimism; (2) changing context, roles and identities; (3) changing relationships; and (4) quality of life. Treatment advances and a new focus on living has altered the context of working with people living with HIV/AIDS and challenges health professionals to find new meanings and relationships within that context. Study findings have implications for the wider health care context and the changing roles and power balances within this arena.     

医疗卫生服务体系整合型改革对医务人员工作动机及行为影响的系统综述

目的:探究医疗卫生服务体系整合型改革中医务人员工作动机和行为的改变.方法:采用系统综述法检索筛选文献,主题综合法提取文献信息,基于ERG理论分析工作动机影响机制.结果:纳入的19篇研究发现整合型改革有利于满足医务人员不同需求层次,提高了工作满意度或降低职业倦怠和工作压力.但是各类整合改革都存在薪酬体制改革滞后,难以弥补...     

医疗保健制度对卫生服务需求行为影响的比较研究

本文从择医、择药及住院费用意识三个方面,就公费和劳保两个组医改前后的卫生服务需求进行分析,揭示了医疗保障制度对职工卫生服务需求的影响。     

Issues in the assessment of continuous quality improvement implementation in health care organizations.

OBJECTIVE: This paper has two primary aims. First, it examines the need for improved assessment of continuous quality improvement implementation. Second, it analyzes current worldwide measures and studies of continuous quality improvement implementation. METHOD: A comprehensive literature review was conducted which included all published (English language) studies of organization-wide continuous quality improvement implementation. RESULTS: Analysis of the content and research methods incorporated into current measures of continuous quality improvement implementation used worldwide supports a strong consensus regarding the major criteria that need to be addressed. However, there are still promising areas for future research, namely increased use of criteria other than the Baldrige categories, increased focus upon financial variables, improved measures of implementation stage/phase and the use of different types of respondents from multiple organizational levels. CONCLUSION: Increased understanding of the empirical benefits and costs of continuous quality improvement in health care organizations is heavily contingent upon the continued development and improvement of measures of continuous quality improvement implementation.     

社区医院健康促进工作质量评价指标体系研究

目的 建立社区医院健康促进工作质量评价指标体系,以期为基层医疗卫生机构健康促进医院(health promoting hospital, HPH)的创建和发展提供借鉴。方法 采用文献回顾和专家访谈初步确定指标框架,通过两轮改良德尔菲专家咨询法建立指标体系,并以百分权重法确定各级指标权重。结果 两轮专家咨询问卷回收率分别为92.60%和85.19%,专家权威系数分别为0.857和0.839;最终形成社区医院健康促进工作质量评价指标体系,包括一级指标3个,二级指标11个,三级指标38个;各级指标变异系数为0.044～0.193,两轮咨询的肯德尔协调系数分别为0.375和0.512(P<0.01)。结论 社区医院健康促进工作质量评价指标体系内容覆盖全面,指标权重设定科学合理,为基层医疗机构创建健康促进医院,并持续开展社区健康促进工作提供了实用的评估工具。     

The impact and integration of behavioural sciences in the education of health care professionals

Health, defined as physical, mental and social well-being, should be adequately conceptualized in organic as well as non-organic terms, thus implying a criticism of some training programmes which ought to recognize the dire need to integrate the socio-behavioural sciences--geography, social anthropology, sociology, psychology, political science and economics--in the education of health care professionals. The two components of this education, medicine and health care and the socio-behavioural sciences, should prepare the professional adequately to practice the science of medicine and the art of the profession in varying socio-cultural contexts of co-existing health care systems. This paper argues that it is only those institutions which integrate the socio-behavioural sciences in their programme of health care education that are on the path of progress by keeping scientific pace with our understanding of the structural realities of contemporary societies.