Health service planning in a British new town.

The initial postwar development of new towns in Britain took place at a time when the present British National Health Service was in its infancy, and few attempts were made to integrate health service planning into the overall planning process. The more recent new towns have been the object of better social planning and, at the same time, the National Health Service has been substantially unified, at first functionally and, in 1974, administratively. In consequence, attempts have been made to use the opportunities which such towns present for planning health services in a comprehensive and integrated manner. The evolution of a planning and implementation structure for health services in Milton Keynes, a new town with a target population of 250,000, is described, together with some of the implications for the administratively unified National Health Service which came into being in 1974.     

空军航空兵场站卫勤信息管理系统的研制

目的：为了推动空军航空兵场站的卫勤保障信息化建设。方法：结合空军航空兵场站的保障特点及要求，设计了集飞行人员健康信息、场站卫勤保障、飞行人员生理心理检测为一体的综合数据库。结果：为空军各级卫生单位实时传递卫勤保障信息、动态掌握飞行人员健康状况提供自动化和智能化手段。结论：该系统的成功运用，有效提高了航空兵场站卫勤保障效率，对提高部队战斗力起到了积极的作用。     

The move to community care and the impact of long-term disability on health service provision: some implications for library services

This paper describes the epidemiological and demographic trends underpinning the current shift to primary health care heralded by the Community Care Act. It suggests that the health service is increasingly treating people suffering from long-term disability. Hospitals no longer provide an appropriate setting for the management of long-term disability as hospital-based practitioners cannot integrate treatment modalities into the everyday life experiences of the patient. Community care introduces a social dimension to the traditional medical model of health. The paper examines the information needs generated by both the social model and the medical model of health and considers the types of information required by each model. It concludes by discussing the potential for librarians to influence health care provision via the type of information they make available to practitioners.     

OneView strategy aligns physicians with Carilion

Carilion's OneView strategy will ultimately integrate and link our ambulatory activities to our members, patients and community. It is our technology level to lift Carilion, our physician partners and patients to a new level of communication, cooperation, service and quality health care. It will take several years to complete the project, but by the turn of the century we will have OneView of our ambulatory world.     

城镇居民医保制度的实践探索与发展趋向

分析了上海市城镇居民医保制度的特点,对部分难点问题和发展方向提出思考和建议,认为城市到农村,城乡保障一体;地区到全省,提高统筹层次;住院到门诊,待遇逐步完善;职工和居民,逐步融合统一将是未来制度的发展方向。     

Involving consumers in health care decision making

This paper considers ways of involving consumers in decisions regarding the allocation of scarce health service resources. Specifically, two levels of consumer participation are highlighted and discussed. These are: (1) at the level of deciding whether or not a particular service should be introduced or its scale changed; and (2) at the level of deciding how best to provide a service once it has been decided that the servicewill be provided. The limitations of the current methods of involving consumers are outlined and two alternative approaches discussed. These are willingness to pay and conjoint analysis.     

Optimal ambulance location with random delays and travel times

We describe an ambulance location optimization model that minimizes the number of ambulances needed to provide a specified service level. The model measures service level as the fraction of calls reached within a given time standard and considers response time to be composed of a random delay (prior to travel to the scene) plus a random travel time. In addition to modeling the uncertainty in the delay and in the travel time, we incorporate uncertainty in the ambulance availability in determining the response time. Models that do not account for the uncertainty in all three of these components may overestimate the possible service level for a given number of ambulances and underestimate the number of ambulances needed to provide a specified service level. By explicitly modeling the randomness in the ambulance availability and in the delays and the travel times, we arrive at a more realistic ambulance location model. Our model is tractable enough to be solved with general-purpose optimization solvers for cities with populations around one Million. We illustrate the use of the model using actual data from Edmonton.     

我国县级公立医院改革的形势分析

在县域医药卫生体制改革中,对形势的基本判断往往左右着县级公立医院改革的价取向和制度安排。笔者对县域公立医院改革形势主要有三个基本判断,第一是人民群众日益增长、升级、多样的医药卫生服务需求同相对落后的医药卫生供给能力是社会主义初级阶段县域医药卫生事业的主要矛盾。县域医药卫生事业的主要矛盾决定了县级公立医院改革必须以提升医药卫生服务能力为中心任务。第二是我国县级公立医院的发展存在着体制性障碍和机制性矛盾,体制性障碍主要指政府对县级公立医院的行政管制;机制性矛盾主要指县域医疗系统的割裂状态、县级公立医院的垄断格局、县级公立医保的被动角色。县域医药卫生体系的发展存在体制性障碍和机制性矛盾决定了县级公立医院改革必须以体制改革和机制创新为主要内容。第三是县级公立医院改革的定位是全民医疗保险体制下县域医药卫生服务供给体制改革。县级公立医院的改革定位决定了理应以解决群众看病难为中心任务,以提升医药卫生服务供给能力为主要路径。     

开展跨领域协作 提高慢性病综合防治水平

目的通过探索开展慢病跨领域协作机制,提高慢病综合防治水平。方法建立专家团队,制订慢病跨领域协作方案,健全慢病防治三级医疗服务网,形成各级协作的诊疗管理流程,加强质量控制,组织专家论证,完善慢病跨领域协作机制。结果慢病规范管理得到明显加强,医疗费用负担减轻,病人的就医流向趋于合理。结论开展慢病跨领域协作机制,有利于提高慢病综合防治水平。     

医疗服务中规模经济的获取利用

从规模经济的概念和来源出发,分析医疗服务的规模经济及其特殊性,认为医院的运营需要保持一定的规模,既不能过小,也不能过大;对于需购置大型设备的医疗服务,若设置一定规模的专科服务机构,比分散在各综合医院提供服务更有经济性;利用互联网络等形式发布医疗信息,进行价格等信息公示,可扩大市场范围;医院间建立联盟,进行医疗服务的垂直与水平整合等.通过以上举措,获取医疗服务的规模经济.

Abstract：

The paper analyzed the economies of scale of medical service and its characteristics according to the concepts and original of such a theory. It holds that hospital operations demands an appropriate size; for medical services in need of procuring large equipments, specialized service units of an appropriate size are more cost effective than service provision in individual hospitals; web release of medical service information and price information can help expand the market size; hospital alliances can integrate medical services horizontally and vertically. The above measures can attain the economies of scale for medical service.     

Reconsidering models of patient satisfaction and behavioral intentions

This article considers several models of how patients integrate their reactions to hospital attributes and how these reactions impact their overall satisfaction and behavioral intentions. It finds that patients combine their reactions to the attributes by means of noncompensatory and nonlinear models to form their overall satisfaction or behavioral intentions.     

Putting theory into practice: a cluster randomized trial with a small number of clusters

Many of the difficulties encountered in the design, organization and analysis of cluster randomized trials arise from the dual nature of such trials; that is, they focus on both the cluster and the individual. A trial now in progress to compare three methods of promoting secondary prevention of coronary heart disease in primary care includes only 21 general practices, but 2142 patients, and thus contains the problems of both small and large samples. With only seven practices in each arm, the trial demanded carefully restricted randomization, may be difficult to analyse, and risks loss of power if one practice should drop out. At the same time, the large number of patients makes for an expensive and administratively complex study. The simultaneous demands of clarity and thoroughness point to an analysis at both cluster and individual level. With two different approaches, however, there may be difficulties of presentation, even if the results agree, and additional problems of interpretation if they do not. Finally, practical considerations may conflict with theoretical demands. Since the trial contained a service element, all patients with heart disease had to be included, even though it would have been more efficient to take only a sample of patients from some practices.     

面向区域医疗的互联网医院平台的设计与应用

目的 创新区域医疗互联网+医疗健康服务模式,优化健康服务流程,统筹整合优质医疗卫生资源.方法 基于互联网医院和数据中心,通过服务模式创新及医疗资源开放等举措,形成资源整合及能力提升的医院集团互联网医院平台.结果 实现互联网+居民就医、互联网+在线诊疗、互联网+健康评估、互联网+分级诊疗、互联网+医疗协同、互联网+远程诊...     

The cost and efficiency of public and private health care facilities in Ogun state,Nigeria

During the 1980s, Nigeria faced difficult economic conditions resulting in a severely constrained budget for public health services. To assess more carefully the costs and efficiency of the public and private health sectors, the Federal Ministry of Health in Nigeria undertook a comprehensive survey of health care facilities in Ogun State in 1987, the analysis of which is presented in this study. The findings suggest that there is potential to increase service delivery within existing budgets by more cost-effective allocation of inputs. Many public and private providers are not operating at full technical capacity. It also appears that public facilities are not using cost-minimizing combinations of high and low-level health workers, in particular, too many low-level staff are being used to support high-level workers. The cost analysis indicates that there are short-run increasing returns to scale for inpatient and nearly constant returns to scale for outpatient services. Economies of scope for joint production of inpatient and outpatient services are not being realized. A major implication of such analysis is that improved resource allocation decisions heavily depend on the existence of information systems at the health facility level which carefully integrate financial information with other appropriate and adequate measures of service inputs, health care quality, facility utilization and ultimately health status.     

Explaining geographies of health care: a critique

This paper considers the ways in which geographers have sought to explain the spatial organisation of health care services. It does so at three interlocking scales: the global/international, the national, and the local. It considers the substantive adequacy and explanatory problems associated with different perspectives and also discusses the normative implications of alternative interpretations of patterns of health care services. The paper notes the ways in which some conventional geographies of health care, which seemed to postulate convergence towards greater egalitarianism in service provision between and within states, have been challenged by changing economic circumstances, and by a changing political and intellectual agenda. The paper also considers some emerging geographies of community-based struggles around health services and discusses their potential and limitations. Finally there is a discussion of the potential contribution, if any, of a distinctively geographical perspective on health care.     

Health-sector responses to intimate partner violence in low- and middle-income settings: a review of current models, challenges and opportunities

There is growing recognition of the public-health burden of intimate partner violence (IPV) and the potential for the health sector to identify and support abused women. Drawing upon models of health-sector integration, this paper reviews current initiatives to integrate responses to IPV into the health sector in low- and middle-income settings. We present a broad framework for the opportunities for integration and associated service and referral needs, and then summarize current promising initiatives. The findings suggest that a few models of integration are being replicated in many settings. These often focus on service provision at a secondary or tertiary level through accident and emergency or women's health services, or at a primary level through reproductive or family-planning health services. Challenges to integration still exist at all levels, from individual service providers' attitudes and lack of knowledge about violence to managerial and health systems' challenges such as insufficient staff training, no clear policies on IPV, and lack of coordination among various actors and departments involved in planning integrated services. Furthermore, given the variety of locations where women may present and the range and potential severity of presenting health problems, there is an urgent need for coherent, effective referral within the health sector, and the need for strong local partnership to facilitate effective referral to external, non-health services.     

Public honour,private shame and HIV: issues affecting sexual health service delivery in London's South Asian communities

Within a wider discussion of health service provision for black and minority ethnic (BME) groups, this paper considers how socio-cultural factors affect the provision of HIV and sexual health services to South Asians in London. It argues that communally held concepts of honour and shame within South Asian communities create a framework of social control with significant implications for HIV/AIDS transmission. It examines the provision of culturally sensitive services to BME communities by ethnically specific and generic service providers through a case study of the Naz Project London. Finally, it proposes an agenda for future research into BME sexual health service provision.     

关于实行“三位一体”县域慢病防控策略的思考

当前,我国慢病防治工作面临严峻挑战。为有效遏制慢病高发态势,保护和增进人民群众健康,本文分析了农村地区慢病防控管理方面存在的主要问题,提出了＂三位一体＂的县域慢病防控策略的基本思路,即分别实现＂县、乡、村＂三级医疗卫生机构之间、＂防、医、管＂之间、＂体系、体制、机制＂之间的三位一体。实行＂三位一体＂的县域慢病防控策略,首先,实现＂县、乡、村＂三级医疗卫生机构各负其责、分工合作的慢病防控新模式;其次,要实现慢病预防、诊治和管理的有机结合;最后,要加强县域医疗卫生机构能力建设、慢病管理体制建设和完善县域慢病防控运行机制,全面提高医疗卫生服务体系整体功能。     

Parenteral Nutrition Complications in a Voluntary Hospital

A prospective study analyzing the complications in 307 patients who had specialized nutrition support administered by their private practitioners was performed and compared to other series in which a nutrition support service exclusively provided such care to patients. The mechanical complication rate of 4.6%, septic complication rate of 2.9%, and metabolic complication rate of 4.2% compared favorably with the reported literature. A new category of complications, the judgmental complication, is described and was 12.7% in the reported series. The Saint Barnabas Medical Center experience suggests that individual practitioners can satisfactorily administer intravenous specialized nutrition support if in fact an involved nutrition support service functions administratively and supportively in the background. (Journal of Parenteral and Enteral Nutrition 8 :385–390, 1983)     

Inventory management of reusable surgical supplies

We investigate the inventory management practices for reusable surgical instruments that must be sterilized between uses. We study a hospital that outsources their sterilization services and model the inventory process as a discrete-time Markov chain. We present two base-stock inventory models, one that considers stockout-based substitution and one that does not. We derive the optimal base-stock level for the number of reusable instruments to hold in inventory, the expected service level, and investigate the implied cost of a stockout. We apply our theoretical results to a dataset collected from a surgical unit at a large tertiary care hospital specializing in colorectal operations. We demonstrate how to implement our model when determining base-stock levels for future capacity expansion and when considering alternative stockout protocols. Our analysis suggests that the hospital can reduce the number of reusable instrument sets held in inventory if on-site sterilization techniques (e.g., flash sterilization) are employed. Our results will guide future procurement decisions for surgical units based on costs and desired service levels.