卫生事业费分配结构调整的政策思考

本文在对三省、三市和三县的卫生事业费调查研究和分析的基础上，对卫生事业费分配结构调整提出了以下改革思路：卫生事业费应考虑国民经济、人口和物价指数三个因素，保证其实际增长与国民经济同步增长对卫生院和合作医疗补助费所占的比重，结合农村地区卫生服务改革和医疗制度建立，应逐步上升，而医院经费结合医疗服务价格的调整等可逐年降低比重；控制卫生服务机构规模，提高卫生资源的利用效率；对贫困地区仍须坚持实行差额补助和专项拨款的政策     

医疗机构固定资产及差额补助分析

该文通过对3省、3市和3县的医疗机构固定资产和差额补助以及收支情况的分析和比较，发现固定资产投资的多少，直接影响到医院经常性费用分配的数量和比例，为此提出如下建议：卫生事业费分配结构调整，在对医疗机构的固定资产投资方面，主要进行增量的调整；对于规模已经过大的医疗机构可以通过对其存量结构调整，以达到缩减规模和提高效率的目的；实行不含固定资产折旧的成本定价政策，逐步取消差额补助。     

论卫生事业费分配结构调整

论卫生事业费分配结构调整同济医科大学郑先荣卫生事业费是国家预算支出的一项内容，指国家用于发展卫生事业的各项费用支出。由于我国经济发展水平不高，国家对卫生事业费的投入是有限的，而人民对医疗卫生的需要量又很大。因此，既要动员社会各方面力量办医，广辟财源，...     

国民经济发展与卫生事业费变动趋势分析

通过对3省、3市和3县国民经济发展和卫生事业经费分配水平及其变动趋势的分析，结果表明经济对卫生事业的发展起着重要的影响作用，国民经济的发展和财政收支状况改善对卫生事业费分配结构的调整有重要影响，保持卫生事业费实际占GDP和财政支出应有一个适当和稳定的比重。     

北京市卫生事业费分配制度改革的设想

卫生事业费分配和使用制度的弊端卫生事业的分配和合用制度是由卫生事业的性质和职能决定的。但是,由于种种原因,现行的卫生事业费分配和使用制度还存在着许多弊病,致使卫生事业     

新时期军队卫生事业费管理办法探讨

在市场经济条件下,要使有限的卫生事业费更好地直接为部队官兵健康服务,根本出路在于改革其分配办法,基本思路是:卫生事业费不再下拨到各医院,而是由各团级单位根据供应实力,按卫生事业费的人员标准和设备标准计领。军队病员到医院就诊、住院一律按标准交费,回所在单位报销。     

改革卫生事业费预算结构和分配方法的探讨

卫生事业费是国家用于防病、治病、保护人民健康的投资,是医疗卫生保健事业存在与发展的重要物质条件,如何科学地分配和使用好卫生事业费,使国家补助医疗卫生机构的有限的资金能够取得较好的经济效益和社会效益,是卫生经济学的一个重要课题,也是当前卫生事业改革工作中迫切需要解决的实际问题。为此,我们对黑龙江省鸡西市历年来卫生事业费的     

从实际出发改革卫生事业经费分配

卫生事业费主要是国家通过国民收入再分配而实现的一种卫生保健投资,是保证医疗卫生保健工作的正常进行和卫生事业发展的主要资金来源。为了使医疗卫生工作更好地服务于我区四化建设和人民群众致富,如何科学地分配和使用好卫生事业费,使有限的资金更好地发挥经济效益和社会效益,是财政工作研究探讨的一个重要课题,也是卫生部门改革工作中亟待解决的实际问题一、现行预算分配方法及弊端     

基于S省市、县级卫生事业费地区分布公平性的测量研究

目的:测量研究卫生事业费地区分布的公平程度,以期为深化医改提供参考。方法:使用2009年S省17市和140县的横截面数据,运用Gini系数计算理论方法,测量卫生事业费的地区分布差异;同时,开展纵向比较,考察2000～2009年17市的Gini系数变化趋势。资料来源于S省卫生部门财务年报和社会经济统计资料。结果:2009年17市卫生事业费Gini系数为0.372;17市卫生事业费Gini系数由2000年的0.200增加为2009年的0.372;2009年140县(市区)卫生事业费Gini系数为0.31。建议:调整卫生筹资政策,加大卫生事业费的财政转移支付力度,提高地区间财政补助的公平程度。     

药检机构由全额预算管理改为差额预算管理的设想

多年来,药检机构一直被认为是“没有收入或收入不稳定、不固定的卫生事业单位”。单位预算的管理形式一直采取全额预算管理。由于国家投资的卫生事业费有限,且预算分配方法不合理,致使药品检验、监督部门开支困难,设备陈旧、房屋失修,严重影响药品检验、监督工作的正常进行,阻碍了《药品管理法》的贯彻实施。随着经济管理体制改革的不断深入,尽管卫生事业费预算分配方法变动不大,但是药检收费标准按卫生部(86)卫药字第34号《关于调整药品审批监督检验收费标准的通知》规定比以前有明显的增加。仅就汉中地区药品检验     

省、市、县卫生事业费分配结构与水平分析

该文在典型调查基础上，从纵向和横向分别对3省、3市和3县的卫生事业经费的分配结构与水平进行了比较，并分析了其变动趋势。结果表明，国民经济发展和财政收支情况的好坏直接影响卫生事业费分配水平。在一个省的范围内，有限卫生资源的分配已较多地倾向于防治防疫和妇幼保健方面，并且人均经费的差距在省、市和县之间正在进一步缩小。     

Social work and health restructuring in Canada and Finland

The health care systems in Canada and Finland are currently in the process of restructuring. Responsibility for care has increasingly shifted to ill persons themselves and to their families and friends. Reduced hospital stays, service privatization and user fees have been implemented to some degree in both countries. These changes are reverberating throughout Finnish and Canadian societies, affecting not only users of health care but also the labour force in health workplaces. Health social workers, at the front line with clients, have experienced new issues which have impacted on their practice with ill persons and their families. In an environment of health care restructuring, they have needed to draw upon their repertoires of knowledge, skills and community networks in order to respond. At the same time, social workers noted that there is a leaner package of health and social service benefits to support patients and families. Social workers have tried to adapt and find new opportunities to practice social work in the changed environment. This small study, initially conducted as a pilot for a larger study, compared the experiences of social workers in Canada and Finland and the perceived impacts of health restructuring on their clients. The findings, seen within the context of changing societal and institutional environments, can help us to better understand some of the impacts of health restructuring on social work and social workers in hospitals and local health centres. Indirectly and directly, these changes also affect clients in the health care system, those whose needs remain uppermost in the delivery of social work services.     

Rationalizing rural hospital services in Kazakstan.

The Soviet health care system placed great emphasis on specialist hospitalization. Primary care, in contrast, was viewed primarily as prophylactic and also identified patients for admission to hospital. This led to long lengths of stays, since patients were provided with outpatient type care in hospital, and unnecessary admissions. The reduction in funding for the health system has exacerbated the top heavy nature of the system and made restructuring of the sector essential. Rural areas in Kazakstan follow a similar structure to other parts of the former Soviet Union. In 1996 a project was undertaken to review the provision of hospital services in one rural rayon (district) just outside Almaty. The approach taken was to emphasize the relationship between activity and financial data. It did this by analysing the link between clinical decisions taken to reduce lengths of stay, management decisions to modify staffing and costs of care. It was shown that substantial savings could be made together with improvements in the quality of care, through a programme of planned restructuring. Some success in inducing change is reported but without a major change in approach to local level management. In order to achieve changes it is important that short and long term alternatives to hospitalization are developed.     

Health care reform and the paradox of efficiency: "writing in" culture.

Widespread global migration is occurring at the same time that health care delivery systems in Western nations are undergoing major restructuring. The call for health care to be more efficient, economical, and responsive to diverse cultural populations has come from several sectors, including governments and researchers. This has led to policies to address perceived deficiencies in health care services. The authors draw on their research at health care institutions in a western Canadian city to probe, first, how the concept of culture is interpreted within organizations; and second, how culture is "written into health systems" as they undergo restructuring. Meanings and interpretations of culture are not transparent; moreover, "writing in" culture is not simply a matter of health care providers learning about their clients' "belief systems" and being sensitive to these beliefs. Belief systems and people's experiences of the care they receive are negotiated within highly complex "organizational cultures," located in broader macroeconomic and political structures, and discourses that shape how health care systems are organized. The authors consider whether current discourses on cost containment are in competition with providing equitable health care services to diverse client populations.     

Home care after hip fracture in a health planning region.

Health-care restructuring has increased the focus on integrating health care. Therefore the study purpose was to quantify patient movement from hospital to home care before restructuring occurred in a health planning district. Hospital discharge abstracts and home care records identified patients with a hip fracture who used home care (n = 353). Patients from acute care were more likely than rehabilitation or convalescent inpatients to wait > 3 days for home care after hospital discharge (RR 1.54, 95% CI 1.18, 2.00). Institution-dwellers were more likely than community-dwellers to wait > 3 days for home care (RR 2.35, 95% CI 1.86, 2.97). Home care rehabilitation clients were more likely than non-rehabilitation users to wait > 3 days for home care (RR 2.10, 95% CI 1.42, 3.09). Waiting time for home care is associated with hospital care setting and the home care service utilized. Evaluations of restructuring efforts should consider accounting for these relationships.     

100% access,zero health disparities,and GIS: an improved methodology for designating health professions shortage areas

The (Health Professions Shortage Areas) HPSA designation process was developed as a mechanism to identify primary care shortage areas eligible for participation in specific federally funded programs including a 10% Medicare supplement, the National Health Service Corps, and health professions training programs. The purpose of this paper was to explore the utility of Geographic Information Systems (GIS) technology as an improved methodology for obtaining HPSA designation status for geographic areas. Results showed that GIS identified 24 Medical Services Study Areas (rational planning areas) in Los Angeles County that met the minimum 3500:1 population-to-primary-care physician ratio for geographic area HPSA designation compared to only three that currently are identified. Authors concluded that restructuring of the state/county responsibilities for HPSA designation is long overdue and that use of GIS as a required methodology would help ensure that all areas in any state that meet the intent of federal legislation are included.