关于吉林省医疗“市场”的现状,问题与对策

关于吉林省医疗“市场”的现状、问题与对策吉林省卫生厅（１３００５１）王博识，梁贵，邵立刚，王琨瑛近年来，吉林省的医疗保健事业在党的改革开放方针的指引下，得以迅速发展，已初步形成了以全民所有制医疗机构为主体，以集体、部门、个体办医为补充的医疗保健机构的...     

论药品流通领域的"市场失灵"及其治理

一、药品流通领域“市场失灵”剖析 首先，医疗卫生事业的本质属性决定了药品流通领域市场形成机制的局限性。医疗卫生事业具有“公益性”，因此为医疗卫生提供需求的产品，一般都通过公共采购的形式，其生产流通都要严格受国家宏观调控。尤其是药品，作为一种特殊商品，关系居民生命安全与健康，它的生产与流通，特别是在价格形成机制上要受国家严格监控，现行价格政策是实行国家定价和市场调节价两种主要形式。这就决定了它是一个竞争不充分的市场，“市场失灵”是自然的。     

正确处理三个关系加强医疗市场监管的探索与实践

近几年来，无锡市在加大对全行业医疗卫生工作监督管理的同时，有序地开放医疗市场。经过几年努力，一个“规范有序、和谐发展”的医疗市场已基本形成。在工作实践中，我们注重把握和处理好以下几个关系。     

德国彩妆引领品牌的中国之路

21世纪前，国际化妆品行业的巨头大多数都涌入中国市场，百货商场渠道已占据稳定的市场份额；然而，在欧美、澳洲以及日韩等国家还有许多独具特色的化妆品品牌，自2006年以来，外资品牌开始了试探性进入中国市场的连续动作，以其形成国内化妆品市场的“新外资品牌”。     

努力提高医疗质量,构建和谐医患关系

婺源县人民医院是一所二级甲等综合性医院，“国家爱婴医院”、“省群众满意医院”。院领导班子坚持“以病人为中心”的服务理念，不断优化质量管理方法，建立长效的医疗质量持续改进机制，提高医疗质量，注重医疗安全，加强医患沟通，构建和谐医患关系，使我院各项事业取得长促发展，形成良好和谐发展局面。     

不良情绪,影响身心健康的大敌

在苏联卫国战争中，法国人包围了斯大林格勒，城内许多苏联人焦虑不安，一夜之间竟患 了高血压。这就是历史上有名的“围城高血压病”。“围城高血压病”告诉人们，社会心理环境中的天灾人祸、遭受失败挫折、歧视虐待和生 活坎坷，都属于损害健康的恶性刺激。它可以使人产生愤怒、惊恐、焦虑、忧伤、失望等不 良情绪而使人患病。心理学家研究表明，这种恶性刺激对健康的危害，主要表现在以下五个方面：1 妨碍心理正常的发育和基本人格的形成幼年时期，正是基本人格形成的关键阶段。如果缺少母爱，或生活在不良的社会心理环境 中，就会妨碍儿…     

为“订份保健报刊,当半个医生”叫好

近几年来，随着经济的不断发展，很多发达地区的家庭，在“酒足饭饱”的同时，纷纷把“银根”投入到家庭成员的自我保健上来。现有很多家庭自订卫生保健知识报刊，自备卫生保健知识，以防病治病为目的。一些人干起了自我保健医生的行当，道是：“订份保健报刊，当半个医生。”据悉此“风”不胫而走，已在我国许多发达地区形成“气候”。善哉！“订份保健报刊，当半个医生。”诚然，当人们温饱不愁，安居乐业之后，自我保健的需求层次亦“水涨船高”，诸如讲究居室的环境卫生、膳食结构的合理、五官体态的健美、子孙后代的聪明才智等等，都提…     

加入WTO后卫生监督执法的主要影响与对策

一、加入WTO后对卫生监督执法的主要影响1．卫生监督管理理念和模式面临挑战加入WTO后，随着健康相关产品市场扩大开放，医疗市场多元办医的医疗服务体系形成和多种经营方式的并存，卫生行政部门的管理方式必须由“行政控制型管理”向“法规服务型管理”转变。卫生监督部门必须实行更加公开透明的，体现公平性和公正性的监督管理。但是，从目前的实际情况看，卫生行政部门尚未完全实现“政事分离”，政府职能尚未完全理清，中介机构、行业协会的功能仍不健全，医疗卫生单位的自觉守法意识还很淡薄，“政府监管、行业管理、单位自律”的医疗卫生市场监管格局尚未形成。     

卫生人才资源开发对策的探讨

在改革开放的实践中，应该说卫生系统已经形成了“人才是卫生事业发展的第一资源”这一理念，“医疗市场的竞争归根到底是卫生人才的竞争”也已成为共识。尤其是90年代中期以后，各级政府和医疗机构都把卫生人才资源开发当作“科教兴医”的一项重要举措，“人才是第一资源”的理念为人们普遍接受。卫生人才资源开发的思路不断拓宽，工     

顺应儿童需要,构建“区域联动”游戏模式

<正>为给予幼儿更大的游戏空间和时间，我园尝试打破室内外游戏区域的界限，遵循“幼儿为主体”“室内外区域一体化”原则，将现有的八个专用活动室和八个户外游戏区域进行一一对应的“捆绑”，如，“绿野仙踪”游戏联盟由生活工作坊和开心小农场对应组合，“奇幻地带”由科学工作坊和灵动沙水区对应组合……形成区域多维联动、资源互通共享的“游戏联盟”游戏模式，让幼儿在游戏中构建教育现场，激发其主动探索、自主学习的兴趣，从而获得成长与发展。     

Hospital ownership and medical services: Market mix, spillover effects, and nonprofit objectives

Hospitals operate in markets with varied demographic, competitive, and ownership characteristics, yet research on ownership tends to examine hospitals in isolation. Here we examine three hospital ownership types – nonprofit, for-profit, and government – and their spillover effects. We estimate the effects of for-profit market share in two ways, on the provision of medical services and on operating margins at the three types of hospitals. We find that nonprofit hospitals’ medical service provision systematically varies by market mix. We find no significant effect of market mix on the operating margins of nonprofit hospitals, but find that for-profit hospitals have higher margins in markets with more for-profits. These results fit best with theories in which hospitals maximize their own output.     

Managed care, vertical integration strategies and hospital performance

Objective. The purpose of this study is to examine the association of managed care with hospital vertical integration strategies, as well as to observe the relationships of different types of vertical integration with hospital efficiency and financial performance. Data and methods. The sample consists of 363 California short-term acute care hospitals in 1994. Linear structure equation modeling is used to test six hypotheses derived from the strategic adaptation model. Several organizational and market factors are controlled statistically. Principal findings. Results suggest that managed care is a driving force for hospital vertical integration. In terms of performance, hospitals that are integrated with physician groups and provide outpatient services (backward integration) have better operating margins, returns on assets, and net cash flows (p<0.01). These hospitals are not, however, likely to show greater productivity. Forward integration with a long-term-care facility, on the other hand, is positively and significantly related to hospital productivity (p<0.001). Forward integration is negatively related to financial performance (p<0.05), however, opposite to the direction hypothesized. Conclusions. Health executives should be responsive to the growth of managed care in their local market and should probably consider providing more backward integrated services rather than forward integrated services in order to improve the hospital's financial performance in today's competitive health care market.     

Income, location, and the demand for health care from public, nonprofit, and for-profit hospitals.

Although, empirically, for-profit hospitals serve few poor and indigent patients, they may be able to shift capital more quickly than hospitals of other ownership types, thereby spatially avoiding poor patients. However, in a market with a relatively high proportion of for-profit hospitals, spatial avoidance of poor patients is not possible because spatial competition will exist in non-poor areas. The study examines hospital choice for maternity care in a market with many for-profits using a gravity model or conditional logit. The analysis shows that poor and Medicaid populations choose for-profit hospitals overall. Income, along with distance, is an important factor in hospital choice.     

Physician and Clinical Integration Among Rural Hospitals

The pressures for closer alignment between physicians and hospitals in both rural and urban areas are increasing. This study empirically specifies independent dimensions of physician and clinical integration and compares the extent to which such activities are practiced between rural and urban hospitals and among rural hospitals in different organizational and market contexts. Results suggest that both rural and urban hospitals practice physician integration, although each emphasizes different types of strategies. Second, urban hospitals engage in clinical integration with greater frequency than their rural counterparts. Finally, physician integration approaches in rural hospitals are more common among larger rural hospitals, those proximate to urban facilities, those with system affiliations, and those not under public control.     

Analyzing hospital market share along product lines.

This article illustrates a method of analyzing market share based on product lines or specific hospital services, using 1990 data from a health service catchment area in South Carolina. Hospital discharges from two specific services: vascular and cardiac surgery; and obstetrics, were used to compute market rates of retention, discharge, escape, commitment, opening, and capture. The results confirm that as hospitals become more specialized, market share analysis based on total discharges is often misleading. Rather, discharges should be disaggregated and separate service areas with different boundaries constructed for different product lines. This method of market analysis can be performed easily and periodically by hospitals to monitor the market situation of their product lines.     

Environmental and Organizational Factors Associated with Hospital Use of GPO Services

Abstract

Given the potential benefits of Group Purchasing Organizations in cost-containment efforts for hospitals on supplies and purchased services, an important question that remains unanswered is what conditions support or hinder the utilization of GPOs by hospitals. Therefore, this study explores the relationship between GPO use by hospitals and their market and organizational characteristics. Data on hospital GPO utilization and other organizational characteristics were combined with secondary hospital market characteristics. Panel logistic regression with random effects and state and year fixed effects analysis was used to examine the relationship between hospitals’ utilization of GPO services and hospitals’ organizational and market characteristics. Overall, the majority of hospitals utilized the services of GPOs. Specifically, the number of hospitals utilizing the services of GPOs increased slightly from 3290 (72.2%) in 2004 to 3337 (74.4%) in 2013. In regression analyses, hospitals utilizing the services of GPOs operated in an external environment with mixed levels of munificence, more dynamism, and less competition. Specifically, hospitals operating in a less munificent environment are more likely to utilize the services of GPOs. The study findings provide organizational decision-makers and policymakers’ insights into how certain market and organizational factors influence hospital strategy choice, in this case, the use of GPOs.     

Students performance vs. hospital performance in the labor market for medical interns and residents. Do hospitals perform better due to asymmetry in information available to them relative to students?

This paper concerns the labor market for medical interns and residents in the U.S., and in particular, the question of whether the current matching mechanism between graduating medical students and hospitals is 'informationally inefficient'. It was found that overall students performed better than hospital programs in contrast to the common claim that hospitals are more likely to perform better due to seeming superiority in analyzing publicly available information or through access to non-publicly available information. We also conducted a similar analysis for the different specialty programs. In six specialty programs the students' performance was better than hospitals, in two specialty programs the hospitals performance was better than the students and in 14 specialty programs the difference in performance was not statistically different from zero. Thus, only in two cases the hypothesis that the specialty market is informationally inefficient cannot be rejected using the data available. It should be noted that this market is atypical (compared with other labor markets) in that we can test whether it is informationally inefficient by using a practical definition adopted from the field of finance.     

Teaching hospitals, universities part ways

For financial and autonomy reasons, university teaching hospitals are splitting away from their sponsoring academic institutions. Sometimes the hospital wants more freedom to react to the healthcare market. But sometimes it's the university that wants to distance itself from the hospital and the accompanying charity load.     

Assessing performance of Taiwan hospitals using data envelopment analysis: In view of ownership

With rapid economic development in Taiwan, people have greater awareness of health care and are paying more attention to it. From the perspective of hospital management, the scale of hospitals and efficiency improvement are of concern to hospital managers. However, the extent of efficiency will differ between public and private hospitals due to their different ownership and goals. The study aims to evaluate the efficiency of public and private hospitals and to investigate the influence of ownership on efficiency of hospitals. The differences between hospitals can be understood by analyzing the features of the organization of hospitals and their geographic environment. In this way, hospitals with relatively low efficiency will be able to make improvements based on concrete evidence. By means of the two‐stage method, the efficiency scores of 182 hospitals in Taiwan are compared. In the first stage, the data envelopment analysis is applied to obtain the efficiency scores of hospitals. The results show that private hospitals are more efficient than public hospitals. In the second stage, Tobit regression is used to investigate the factors influencing efficiency obtained by the data envelopment analysis. The results indicate that there are differences between ownership in market competition and the average length of stay.