杭州地区大型公立医院涉外医疗现状调查

以杭州市三级公立医院为典型调查对象,通过对医院工作者和在杭外籍人士的双重视角的问卷调查,结合文献研究,发现和总结杭州市公立医院涉外医疗服务方面存在以下4个普遍性问题:医生与外籍患者存在沟通障碍,医疗服务信息沟通不到位,服务环境和服务态度还不尽人意,医疗保险及收费体制问题.据此提出了政府完善涉外医疗服务体系的政策建议,包括要创建与国际接轨的医疗服务质量管理规范、收费体制改革及医保管理和涉外医疗服务机构的规划和宣传,以及医院内部关键要素的管理对策.

Abstract：

The study focused on tertiary public hospitals in Hangzhou,investigating the comments of both hospitals workers and foreigners in the city with questionnaires and literature search.The foilowing four problems were identified in the study in the foreigner medical services in Hangzhou:Communication barriers between doctors and foreign patients,insufficient communication of medical service information,poor service environment and service attitude,and payment mechanism for medical insurance and charges.On such basis,the authors recommended policy changes for the government to improve foreigner-oriented medical services,including building the regulations up to intemational customs for medical services,reforms in the payment system,medical insurance management,as well as planning and promotions of foreigner-related service institutions,and management strategies for key elements within the hospital     

完善医疗保障制度实现全民医保

介绍了上海医疗保障体系的概况和实施成效,分析存在的问题和面临的挑战,提出完善医疗保障体系的总体目标和重点任务.上海已初步形成"三纵三横"的医疗保障制度体系,为减轻参保人员医疗费用负担、推动经济社会发展起到了积极作用,已基本实现国家医改意见中提出的基本医疗保障制度建设近期目标.为进一步贯彻落实国家医改要求,上海将通过整合各类制度、缩小待遇差距、完善医保管理、建立老年护理保障制度等举措进一步完善医疗保障体系,力争2012年户籍人口医疗保障制度覆盖率达到98%,常住人口覆盖率达到90%.

Abstract：

The paper introduces an overview of Shanghai medical security system, analyzes its effectiveness and challenges, and put forward overall goals and key tasks in the future. Shanghai has formed a multiple, medical security system and basically achieved the short-term goal of medical security system establishment which was requested to put forward in national health system reform. Shanghai medical insurance system has played a positive role in promoting economic and social development and reducing the burden of medical expenses. To further implement requirements of national health system reform, Shanghai will be conducting the integration of different schemes , narrow down the gap of benefit packages, improvement of health care management and the initiatives of nursing care insurance to further improve the medical security system, and strive to cover 98% of household population and 90% resident population in 2012.     

医院应急医学救援能力评估指标体系构建

目的 构建医院应急医学救援能力评估指标体系,为各级医院提供应急医学救援能力评估工具.方法 采用情报调研、自由访谈、专家咨询和层次分析方法构建医院应急医学救援能力评估指标体系.结果 建立了由5个一级指标、16个二级指标组成的医院应急医学救援能力评估指标体系.结论 指标体系适用于不同类型和等级医院应急医学救援能力的评估,评估指标较好的代表了评估需求.

Abstract：

Objective To build an evaluation index system for emergency medical assistance capability of the hospitals and provide an evaluation means for hospital capability of emergency medical assistance(HCEMA).Methods Literature search,free interview,expert consultation,and analytic hierarchy process(AHP).were used to build an evaluation index system for emergency medical assistance capability of the hospitals Results The HCEMA evaluation system consists of 5 grade-1 indexes and 16 grade-2 indexes.Conclusion The evaluation system applies to evaluating the capability of medical rescue assistance of hospitals with varying types and gradas,as the evaluating indexes meet the demands satisfactorily.     

我国合理用药监测体系建设初步探讨

建立国家合理用药监测体系对促进临床合理用药、落实国家基本药物政策、促进医疗质量和医疗安全的持续改进具有重要意义.概括了合理用药监测工作的国际经验,介绍了我国合理用药监测体系初步建立的情况,并针对目前存在的问题就如何进一步完善监测体系进行了分析和探讨.

Abstract：

A detection system for rational drug use is vital for promoting rational drug use clinically, implementing the primary drugs policy of the state, and encouraging constant improvement of both quality of care and medical safety. This paper presented a summary of international experiences on rational drug use, introduced the initial progress to build a detection system for drug use in China, and came up with analysis on measures to further improve existing defects.     

四国医疗风险与预警监测管理模式分析

通过检索英国、美国、加拿大、澳大利亚4国医疗风险管理相关官网资料,比较4国医疗风险管理相关机构设置、政策法规和不良事件上报管理机制.4国均设立国家级病人安全管理机构,采取国家、地方、医疗机构和非政府组织多级综合管理;美国以法律法规,英国、澳大利亚以指南作为医疗安全的政策保障;4国通过国家主导或与行业协会合作,管理不良事件上报.启示我国要加强医疗安全管理的组织机构建设,健全医疗安全管理制度并倡导安全文化,建立国家级医疗安全事件报告和学习系统,提高医疗风险管理水平.

Abstract：

Comparison of the institutional setup, policies and adverse event report mechanism for medical risk control in the countries of UK, USA, Canada, and Australia by means of browsing information on their official websites. It is found that these countries maintain a national patient safety authority, coupled with a tiered management at national, local, medical institutions and NGOs level; the USA pattern features laws and regulations, that of UK and Australia features guidelines as policy guarantee for medical safety; these countries regulate adverse event reporting by either government leadership or cooperation with trade associations. Inspirations from this study suggest China to enhance institutional construction, complete regulations, and advocate the culture for medical safety, and to build the national-level reporting and study system for medical safety events, and improve medical risk management.     

上海市医疗机构设置规划研究

在分析上海市医疗资源配置、需求与利用现状的基础上,结合未来发展需求,探讨了上海市"十二五"期间医疗资源配置的总体目标、原则、规划重点及各级卫生行政部门的主导作用.

Abstract：

Based on the current status of allocation, demands and utilization of medical care resources and the needs for future development in Shanghai, the overall objectives, principles, key plans of allocation of medical care resources in the 12th Five-years Plan in Shanghai and the leading role of health bureaus at all levels were discussed.     

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.     

基于数学模型的海南省区域性灾害医学应急体系构建

拟用灾害医疗应急管理学科和数学学科之间相互交叉的研究思路,采用建立数学模型等多种研究方法,对海南省区域理化脆弱性和社会脆弱性进行评价,寻找降低本区域脆弱性的方法;应用时间序列模型预测灾害预警级别;用概率的方法计算得到各地区时间和空间上应配备的医疗应急所需的医务人员、设备和药品数,并计算出在此基础上发生各种非常规事件时人员被救治的概率,从而达到提前预警和精确动员医疗应急力量的目的.

Abstract：

A multi-disciplinary study is proposed for emergency response management of disaster medical and mathematical discipline in the paper. The authors propose to evaluate the physical and chemical fragility and social fragility of Hainan province to search for methods to minimize local fragility; predict the level of disaster pre-warning using the time sequence model; calculate the medical personnel, equipments and drugs to be deployed at specific time and space by means of the probability method, and calculate on this basis the probability of the number of persons to be rescued against various emergencies. This aims at sending warning in advance and precisely mobilizing resources for medical emergency response.     

流动人口基本公共卫生服务均等化调查

目的 了解流动人口与当地常住人口基本公共卫生服务不均等的情况.方法 通过现场调研和访谈,抽样调查了浙江省某县的流动人口和常住人口各581人,了解两种人群的基本公共卫生服务在投入、机会.结果 上的不均等情况.结果 流动人口中享受过医疗救助的比例仅占7.8%,低于常住人口的13.4%;有40.9%的流动人口会因为较高的医药费用而不去就医,远远高于常住人口;流动人口妇科检查率为58.7%,低于常住人口(67.7%).结论 应增加公共卫生机构资源配置和财政投入,发展和完善社会医疗保障体系,促进不同人群间基本公共卫生服务的均等化.

Abstract：

Objective To probe into the inequality found in primary public health service available to the migrant population and permanent residents. Methods With on-site interviews, 581 migrant workers and 581 permanent residents in a county in Zhejiang province were surveyed, to learn the inequalities between the two in the expenditure, access and outcomes of the public health service accessible to each. Results only 7. 8% of the migrant population ever had access to medical aid, a ratio far below that of the permanent residents; 40. 9% of the migrant population may turn down medical service beyond their affordability, a ratio far higher; for the migrant population, their ratio of gynecological checkup is 58. 7%, lower than that of the permanent residents (67. 7%). Conclusion Resources and financial allocation to institutions of public health should be enhanced, and social medical and insurance system should be developed and improved, in an effort to encourage the equality of primary public health services accessible to various sectors of the population.     

四川汶川地震灾后医疗救助基线调查

目的 了解地震灾区居民灾后医疗需要及困难人群变化情况,为灾后医疗救助工作提供政策建议.方法 采用现场入户问卷调查、文献研究等方法,对灾区10个县(市、区)4 380户居民的收入、患病率及精神健康状况进行调查.结果 在极重灾区,农村及城镇中分别有80.4%、52.8%的居民靠政府救济生活;困难群众的比例由灾前的5%左右增加到极重灾区的75%以上,重灾区的15%左右,一般灾区的10%左右.测算2009年四川省新增医疗救助资金将达到3.5亿,超出2009年预算的2倍.极重灾区每千人两周患病率是2003年第三次卫生服务调查的2倍多,并以急性呼吸道疾病、类风湿等疾病为主;极重灾区有将近70%的居民精神健康处于高危险状态.结论 应加强医疗救助资金的筹集与使用管理;对灾后医疗救助人群实行动态管理.根据灾后卫生服务需求及灾害发生后的病伤特点,制定、调整相应的医疗救助服务包,加强医疗救助与基本医疗保险制度的衔接.     

医疗救助制度的国际经验及对中国的启示

医疗救助制度是医疗保障制度的重要组成部分,也是衡量一个国家医疗保障制度是否完备和保障水平是否充足的重要标志。为提高贫困人群的医疗服务可及性,缓解重特大疾病带来的沉重负担,国际上绝大多数发达国家都依托各自的医疗保障体系,建立了不同的救助机制。本文对典型国家的医疗救助机制进行了比较研究,发现发达国家公共医疗保险制度多内嵌重大疾病保障机制、向低收入群体提供倾斜性保护,同时设有完备的家计调查式医疗救助制度,并鼓励通过发展商业健康保险释放公共医疗体系压力。基于此,本文从公共资源向低收入弱势群体倾斜、科学界定救助对象、合理确定医疗救助服务范围和标准、加强制度衔接与协调等方面提出了完善我国医疗救助机制的建议。     

汶川地震灾后紧急医疗救助评估及震后医疗救助方案探讨

通过运用现场凋查和专家咨询等研究方法,全面总结了汶川地震医疗救助工作取得的经验,分析存在的问题.对紧急医疗救助过程进行了总结与评估,了解了居民因灾受伤及健康状况,并对灾后医疗救助费用进行了估算,提出了有针对性的医疗救助方案改进措施,建议重视地震灾害的特殊性,建立相应的特殊应急预案;提出发展灾害医学、培养灾害医学人才、提高医务人员紧急医疗救援技能、发展志愿者管理体系等中长期的发展计划.     

从组团式援藏看西藏医用辐射防护监测工作的希望之光

目的 了解西藏医用辐射防护现状。保障西藏医疗卫生机构医用辐射工作人员、患者、群众的身体健康与安全。方法 通过多年医用辐射防护监测工作的资料累积，以部分地市为例，分析具有西藏特色的发展历程。依据西藏医用辐射监测的特点，结合组团式援藏帮扶西藏医用辐射监测工作实际经验，分析影响西藏放射工作人员、公众健康与安全的因素并提供相应的应对策略。结果 西藏医用辐射监测工作基础薄弱，在实际医疗卫生机构开展放射诊疗过程中缺乏日常监测以及监督管理等，存在较大的安全隐患。结论 必须坚持在医疗卫生机构建设、验收、运行等各个环节加强监督管理，并在组团式援藏工作模式下，建立西藏本地医用辐射监测队伍，提高西藏医用辐射监测水平，才能切实消除隐患，保证医疗卫生机构长期安全稳定的运行。     

国际医疗救援合作的初步探讨

阐述了阿尔及利亚、伊朗、印度尼西亚的地震、海啸医疗救援经验。探讨了通过及时快速的救援信息交流、在野战医院功能辐射区域内共建医疗急救站、合作进行卫生防疫、恢复卫生所和基层医院及大型医院救治功能、培训医务人员等方式,巩固和加强各个救援队之间的合作,提高灾后国际医疗救援水平。通过加强国际医疗队合作,可以充分发挥各自医疗优势,有效利用医疗资源,加快灾区医疗体系重建。     

上海市城市弱势群体医疗保障制度的现状、挑战与对策

城市中的低收入群体以及由于疾病、残疾等原因导致贫困的人群在医疗保障方面往往处于弱势,这部分人群需要更为有效的医疗保障。本文分析了上海市弱势群体的基本医疗保险、医疗救助、补充医疗保险等政策规定;在全面梳理弱势群体医疗保障制度的基础上,分析了保障体系当前在覆盖人群、保障内容、公平性与效率方面所面临的挑战;并提出明确定位、加强制度衔接,建立收入支出相关联的保障对象确定机制,对城镇居民基本医疗保险参保人群予以政策倾斜,保障范围向常见病、慢性病辐射等进一步完善制度体系的策略。     

加强贫困人口医疗救助研究的必要性分析

贫困人群有其自身的人口学和社会经济学特征,在面对健康风险时,具有较大的脆弱性.因病致贫、因病返贫和因贫致病在我国贫困地区已形成一种恶性循环.当前我国城镇职工医疗保险与新型合作医疗在低收入人群的覆盖面窄、筹资渠道不畅、保障受益面小,而低收入人群健康风险大,低收入人群的医疗需求相对下降.对于贫困人口医疗救助存在的共性问题是:贫困人口的确定问题、资金的筹集与管理、医疗救助的内容与力度、如何建立贫困人口医疗救助的长效机制问题.     

健康保障托底:医疗救助制度建设的地方实践及未来展望

本文结合某县的实际情况,从政策托底、城乡统筹、分类实施三个方面总结了医疗救助制度的发展特点。并从四个方面分析了医疗救助制度面临的现实挑战:政策实施偏差,政策制定与实际情况矛盾重重;救助比例偏低,贫困程度及贫困脆弱性难以缓解;筹资渠道较窄,制度运行经济基础有待夯实;事后救助效率低,医疗救助内卷化问题依然严峻。并在此基础上,提出了进一步完善医疗救助制度的对策思考。     

城镇弱势群体面临的医疗保障问题与对策探讨

解决城镇弱势群体医疗保障问题,其切入口应放在职工基本医疗保险制度与医药卫生体制改革的大背景下,以基本医疗保险作为主体框架,在此基础上,进一步扩大医保覆盖面,提高保障力度,建立和完善城镇弱势人群的医疗救助制度和重点疾病的干预机制。     

关于中国建立特困人口医疗救助制度的必要性探讨

通过对贫困人口的健康状况,健康公平状况,健康制度享有情况以及其对实现卫生目标的作用和意义等方面的分析讨论,并在与国外有关情况的对比分析的基础上,提出了在中国建立特困人口医疗救助制度的建议。认为建立这样一种制度将有助于我国社会经济的健康发展,并进一步推动扶贫工作的开展,更为重要的是,它对于改善我国人口的健康状况,改善卫生公平性以及提高卫生部门的效率具有十分重要的意义。它是确保我国实现其卫生目标的最佳策略选择之一。