社区卫生服务"院办院管"模式的利弊分析

目的:分析社区卫生服务"院办院管"模式的利弊所在.方法:以问卷调查的方式,调查深圳市龙岗区全区范围内的117家社区卫生服务中心.同时对中心主任进行深度访谈.结果:117家社区卫生服务中心,均由医院举办,其中,一级医院办32家,二级医院办85家.二级医院举办社区卫生服务中心房屋建筑面积更大,业务用房设王更完善;工作人员数量相对较大,结构构成相当;收支平衡状况较优;服务开展综合情况较好.结论:"院办院管"模式凸显了资源优势、管理优势、保障优势、转诊优势、服务优势.促进了社区卫生服务的良性运作;弊端在于,社区卫生服务与医院服务的理念相抵触;社区卫生服务受举办主体医院的等级水平的影响,在社区卫生服务中心表现为:软硬件配备情况不均衡,运营情况不均衡,服务能力不均衡.     

十堰市社区卫生服务资源配置存在的主要问题与对策

目的:了解十堰市社区卫生服务资源配置现状及存在的主要问题,为制定社区卫生服务相关政策提供科学依据。方法:对十堰市社区卫生服务现状进行调查统计分析。结果:调查显示,十堰市社区卫生服务机构全部为非营利性机构;社区卫生服务机构业务用房由政府无偿提供的8家,占12.3%,本单位自筹租金的57家,占87.7%;社区卫生服务中心、站业务用房面积达标率分别为54.5%、51.9%,;89.2%的社区卫生服务机构纳入城镇职工医疗保险;社区卫生服务人员887人,其中卫技人员743人,占83.8%,医护比为1:0.84。结论:根据研究结果和存在的主要问题提出以下对策:统筹规划,科学配置社区卫生服务资源;建立稳定的社区卫生服务补偿机制;加快培养全科医学人才,提高社区卫生服务人员素质。     

十堰市社区卫生服务资源配置状况调查

目的了解十堰市社区卫生服务资源配置基线数据,为制定社区卫生服务相关政策提供参考。方法对2005年9月十堰市社区卫生服务基线调查材料进行统计分析。结果十堰市城区人口55万,社区卫生服务中心11家,社区卫生服务站54个,全部为非营利性机构,有58家纳入城镇职工医疗保险,占89.2%,社区卫生服务中心、站业务用房达标率分别为54.5%、51.9%;社区卫生服务人员887人,其中卫技人员743人,占83.8%,医护比为1:0.84。结论十堰市社区卫生服务机构配置和卫生服务人力资源总量符合国家标准,但存在着分布不均的情况,全科医学人才缺乏。     

关于通过双向转诊机制节约医保基金的思考

双向转诊应坚持"以病人为中心",同时兼顾转诊各方的利益,大医院可以通过双向转诊来扩大影响增加病源,提高病床周转率和院外收入,同时在业务技术上扶持社区卫生服务;社区卫生服务中心在医疗技术上有了依靠,解除了后顾之忧,自身业务技术得到培训,又能促进社区卫生服务可持续发展.     

社区卫生服务中心员工绩效考核体系的研究

<正>随着医疗卫生体制改革的逐步深入,社区卫生服务中心俗称一级医院或乡镇卫生院,为了适应社区卫生服务发展的需要,必须加强社区卫生服务中心人力资源管理,改进员工的绩效考核,以提高社区卫生服务中心员工的工作效率、服务质量。我中心是一所从二级医院分离出来的医疗机构,始建于2006年,与医院实行医疗设备等资源的共享,是一所二级医院支持下的社区卫生服务中心,主要是开展医疗、预防、保健、康复、健康教育与计划生育指导等"六位一体"的社区卫生服务。     

武汉市洪山区社区卫生服务站管理现状及未来发展浅探

目的为加强社区卫生服务站的管理,促进社区卫生服务发展,对社区卫生服务站管理现状进行分析讨论,并提出改进建议。方法座谈访问和发放问卷相结合。结果社区卫生服务站的管理主体有区卫生行政部门和社区卫生服务中心;政府办中心是社区卫生服务站管理的主要力量;个人办站、企业办站数占全区总站数64.4%;中心与站一体化管理关系较少,80.0%为业务管理关系。结论坚持社区卫生服务中心作为站的管理主体,充分利用辖区中心资源优势加强站的管理;提高政府办站、医院办站比率;大力推进一体化管理;加强业务分类管理。     

社区卫生服务中心常见感染性疾病用药情况分析

目的了解社区卫生服务中心常见感染性疾病的抗菌药物、基本药物、针剂的使用情况,为规范社区卫生服务中心用药行为、提高服务质量提供科学依据。方法按整群抽样的方法抽取2013—2014年深圳市龙岗区8所医院下属的社区卫生服务中心常见感染性疾病的处方。用excel录入处方数据,并引入8个评价指标进行分析。采用TOPSIS法对8所医院下属社区卫生服务中心常见感染性疾病用药的合理性进行排序。结果 8所医院下属社区卫生服务中心的用药指标值有一定差异。结论社区卫生服务中心针剂使用情况良好,基药使用情况有待提高;社区卫生服务中心抗菌药物使用情况良好,私立医院下属社区卫生服务中心抗菌药物使用情况需进一步加强。     

社区卫生信息化 居民就医更温馨——闵行区华漕镇社区卫生服务中心介绍

华漕镇社区卫生服务中心地处闵行区虹桥交通枢纽核心区域,是一级甲等非营利性公立医疗机构。近年来中心以信息化建设为抓手,转变社区卫生服务运行机制和服务模式,不断提高健康管理效率和水平。一是全覆盖建立居民电子健康档案,实现与分中心、社区卫生服务站、全科团队、村卫生室信息互联互通,为减少重复检查和不合理用药提供了信息支撑。     

郑州市社区卫生服务中心与市级医院消毒质量监测结果比较

目的了解郑州市社区卫生服务中心与市级医院消毒质量差距,以便改进和提高。方法现场抽样,对郑州市社区卫生服务中心与市级医院消毒质量进行监测。结果社区卫生服务中心与市级医院平均消毒合格率分别为77.5%和94.5%;物体表面84.0%和97.3%;医护人员手78.1%和88.8%;使用中消毒液88.5%和100.0%;室内空气59.6%和81.8%;高压灭菌器81.5%和100.0%;紫外线灯60.9%和100.0%。结论郑州市社区卫生服务中心平均消毒合格率明显低于市级医院,尤其是室内空气、紫外线灯合格率明显偏低。消毒工作存在薄弱环节,应加强管理,提高质量。     

城镇社区卫生服务管理模式的探讨

文章对广州市社区卫生服务工作的现状进行了调查分析,通过对广州市越秀区妇幼保健院承办社区卫生服务中心——流花街社区卫生服务中心管理经营模式的分析,探讨在当前形势下二级医院承办社区卫生服务中心的管理模式。     

公立医院法人治理视域下的会计治理作用探讨

坚持公立医院的公益性和非营利性,构建现代公立医院的法人治理结构,积极发挥会计治理在信息披露和监管中的作用,致力于在医疗服务信息不对称的条件下,有效提升公立医院服务质量和效率,真正实现公益目标是推动"新医改"顺利进行的保证。依据这一原则,文章对构建现代公立医院法人治理结构并发挥会计治理作用的原则和问题进行了分析,并提出了对策建议。     

Measuring charitable contributions: implications for the nonprofit hospital's tax-exempt status

Since 1985, some nonprofit hospitals have tried to measure the magnitude of their charitable contributions in order to protect themselves from challenges to their nonprofit tax-exempt status. Using a sample of 562 Catholic nonprofit hospitals, this research shows that these charitable contributions may be defined and measured in several different ways, each having methodological advantages and disadvantages. The data indicate that charity care contributions vary widely, are unequally distributed across the sample of hospitals, and are influenced by the characteristics of the people in the local community and not by the characteristics of the health care delivery system. These findings suggest that legislators may be correct when questioning the rationale for the tax-exemption accorded to virtually all nonprofit hospitals. Further, it suggests that nonprofit hospital administrators can protect the tax-exempt status of their hospital by emphasizing the charitable contributions it makes by absorbing the unreimbursed costs from Medicare and Medicaid.     

Protecting the public interest: the role of the state attorney general in regulating hospital conversions

Increasingly, nonprofit hospital have been responding to market pressures by giving up their tax exemption and selling hospital assets to for-profit corporations. In 1995 alone, fifty-nine nonprofit hospital completed full-asset sales or joint ventures. Hospital managers and board members should understand the legal and regulatory environment surrounding hospital conversions. State attorneys general are taking a more active regulatory role. This discussion describes the application of laws governing charitable trusts and nonprofit corporations to hospital conversions, as well as the central role of the attorney general in the enforcement of such laws. The 1996 Michigan circuit court ruling in Kelley v. MAHSI provides an insightful case study, illustrating a strict application of the law to a joint-venture hospital conversion. The implications of this case will be discussed along with the larger implications of more aggressive state regulation of hospital conversions.     

An empirical comparison between the board''s strategic role in nonprofit hospitals and in for-profit industrial firms.

As the health care environment becomes more competitive, nonprofit hospitals are under pressure to adopt for-profit business practices. Based on an extensive field study, this research examines the central issue of organizational governance by comparing the strategic roles of nonprofit hospital boards with for-profit industrial boards. The results show that nonprofit hospital boards are generally more involved in the strategic decision process than their for-profit counterparts. If this governance activity is seen as desirable, hospital boards should exercise caution in emulating for-profit board practices.     

产权改革对广东省医院运行状况影响研究

收集与医院退出市场行为相关的数据，研究在营利性、非营利性及国有和私有产权共存的医疗产业中，医院退出医疗市场行为与其运营效率的关系。应用医院的相对无效率残差、产权形式和其他相关因素来分析1999年至2003年广东省医院的退出行为。在方法上，将医院因为承担非营利性工作所导致的无效率从决定医院退出行为的运营效率中分离出来考虑。结果发现，相对无效率对营利性医院退出医疗市场的行为影响很大．而相对无效率对国有非营利性医院在医疗市场中存在无明显影响。产权改革既不是提高医院运营效率的必要条件也不是充分条件：医院运营效率的影响是多方面的，政策性负担是重要的影响因素。     

Obstacles in the Development of Nonprofit Hospitals in Georgia

The most common form of ownership of medical establishments worldwide is a nonprofit organization. In contrast, the number of nonprofit medical institutions in Georgia is very scarce, while private profit organizations hold about 90% of the medical market. The goal of the research is to study the factors that affect the development of nonprofit hospitals in Georgia. Since there are very few nonprofit medial institutions in Georgia, we hypothesize that there is not enough motivation for functioning of such institutions. For the purposes of this research, six in-depth interviews were conducted with managers and experts of nonprofit organizations. As the research demonstrated, there is no sufficient motivation for functioning of the nonprofit form of medical organizations. Although the Tax Code provides tax benefits, they exist only in a token way and do not support the development of nonprofit medical organizations. It is necessary to improve the tax benefits provided for nonprofit hospitals in the Tax Code and share the world experience in order to increase number of nonprofit organizations in Georgia. It is recommended for Government to give more support to nonprofit organizations, in order to increase their functioning efficiency and bring incentive for development of new nonprofit medical institutions.     

The consumer welfare implications of the hospital ownership mix in the US: an exploratory study

This paper offers an empirical test concerning how hospital ownership mix affects consumer welfare in the US. The test compares the market benefits and costs resulting from an increased presence of nonprofit hospitals by observing empirically how the nonprofit market share impacts hospital care utilization at the margin. The empirical results suggest that too many not-for-profit and public hospitals exist in the inpatient care segment of the typical hospital services industry of the US. In contrast, the empirical findings indicate that too many for-profit hospitals operate in the outpatient care portion of the hospital services industry. The policy implication is that more quality of care per dollar might be obtained by promoting increased for-profit activity to inpatient care and more nonprofit activity to outpatient care in some market areas. This conclusion, however, is tempered with several caveats. We discuss these and also make recommendations for further research.     

Balancing incentives in the compensation contracts of nonprofit hospital CEOs.

Given the considerable insight into corporate governance achieved through studies of executive compensation in proprietary firms it is surprising that executive contracting in nonprofit organizations remains largely unexplored. In this paper, we use the multitask principal agent model of Holmstr?m and Milgrom [The Journal of Law, Economics and Organization 7 (1991) (Suppl.) 24] to argue that nonprofit hospitals represent an optimal response to information asymmetries between managers and boards. For a board with multidimensional objectives, the agency problem is getting top executives to distribute their efforts across all dimensions of the hospital's mission. The nonprofit form is preferred because the absence of high powered incentives such as share ownership reduces executives' incentives to place undue emphasis on improving financial performance at the expense of important but less observable tasks. Using newly available compensation data we test the model by comparing the conditional distributions of earnings for industrial and nonprofit hospital CEOs in Ontario. Our best estimates are that CEOs in publicly traded firms earn twice as much on average as those in similarly sized nonprofit hospitals but bear roughly eight times the income variance. Estimates of the associated degree of risk aversion are well within conventional bounds and are consistent with the trade-off between insurance and incentives predicted by the theory.     

Church ownership and hospital efficiency

Using a sample of California hospitals, the effect of church ownership was examined as it relates to nonprofit hospital efficiency. Efficiency scores were computed using a nonparametric method called data envelopment analysis (DEA). Controlling for hospital size, location, system membership, and type of church ownership, church-owned hospitals were found to be more frequently in the efficient category than their secular nonprofit counterparts. The outcomes have policy implications for reducing healthcare expenditures by focusing on increasing outputs or decreasing inputs, as appropriate, and bolstering the case for church-sponsored hospitals to retain the tax-exempt status due to their ability to manage their resources as efficiently as (or more efficiently than) secular hospitals.     

Reexploring Differences among For-Profit and Nonprofit Dialysis Providers

Objective. To determine whether profit status is associated with differences in hospital days per patient, an outcome that may also be influenced by provider financial goals. Data Sources. United States Renal Data System Standard Analysis Files and Centers for Medicare and Medicaid Services cost reports. Design. We compared the number of hospital days per patient per year across for‐profit and nonprofit dialysis facilities during 2003. To address possible referral bias in the assignment of patients to dialysis facilities, we used an instrumental variable regression method and adjusted for selected patient‐specific factors, facility characteristics such as size and chain affiliation, as well as metrics of market competition. Data Extraction Methods. All patients who received in‐center hemodialysis at any time in 2003 and for whom Medicare was the primary payer were included (N=170,130; roughly two‐thirds of the U.S. hemodialysis population). Patients dialyzed at hospital‐based facilities and patients with no dialysis facilities within 30 miles of their residence were excluded. Results. Overall, adjusted hospital days per patient were 17±5 percent lower in nonprofit facilities. The difference between nonprofit and for‐profit facilities persisted with the correction for referral bias. There was no association between hospital days per patient per year and chain affiliation, but larger facilities had inferior outcomes (facilities with 73 or more patients had a 14±1.7 percent increase in hospital days relative to facilities with 35 or fewer patients). Differences in outcomes among for‐profit and nonprofit facilities translated to 1,600 patient‐years in hospital that could be averted each year if the hospital utilization rates in for‐profit facilities were to decrease to the level of their nonprofit counterparts. Conclusions. Hospital days per patient‐year were statistically and clinically significantly lower among nonprofit dialysis providers. These findings suggest that the indirect incentives in Medicare's current payment system may provide insufficient incentive for for‐profit providers to achieve optimal patient outcomes.