OECD国家卫生保健服务体系的现状及其绩效

大部分OECD国家都有相当成熟的卫生保健服务体系，并向其民众提供了很好的卫生服务，本文利用OECD官方网站（www．oecd．org）、WHO及经济学家智力联合公司（www．eiu．com）布的相关数据，概述了六个国家卫生体系的现状及其绩效。     

医院绩效评估的探讨

随着卫生事业的改革开放和我国加入WTO，医疗服务作为一种专业服务将进一步对外开放。医院是产生医疗服务产品的机构，其经营宗旨是不断满足公众对医疗卫生服务的需求，其管理目的是降低成本、提高效率，为病人提供高质量的服务。医院管理者逐步认识到绩效管理在改善医院经营业绩、培养优秀人才、激励员工等方面的重要性。     

印度卫生系统绩效以及对我国的启示

一、中印两国的可比性我国和印度均是亚洲国家,两国无论是在地理环境、人文风俗还是历史背景上都有许多相同之处。(1)两国都是发展中国家,经济水平比较接近。根据1997-1999年世界发展援助委员会分类,印度属于低收入国家,年人均收入少于765美元;我国属于中低收入国家,年人均收入     

儿童卫生绩效评估指标体系框架的构建

文章系统回顾和总结了国外卫生绩效评估相关的理论模型,以及儿童卫生绩效评估的研究实践,并结合我国儿童卫生工作现状,初步提出了儿童卫生绩效评估指标体系框架。该框架包括儿童卫生投入、产出、结果 3个部分,内容涉及政策制定与落实、资源配置、系统管理、保健服务提供、疾病筛查与干预、服务监管、知晓与满意度、生存状况、营养水平和患病情况等10个方面。     

卫生系统反应性的概念与测量

《2000年世界卫生报告》将反应性作为评价卫生系统绩效的三大主要目标之一。本文对反应性的概念、内容、重要性、WHO发展反应性的战略目标、测量工具及评价方法、中国反应性的得分、在世界各国中排位及原因等进行简单介绍,并对反应性的测量、评价方法作初步的探讨。     

公立医院战略绩效管理体系概念框架研究

探讨了开展公立医院战略绩效管理的必要性,剖析了当前公立医院绩效管理的弊端及实质,结合对战略绩效管理理论和医院战略绩效内涵特征的分析,提出了集本质特征、功能定位和未来发展于一体的,包含了2个层面、4个模块和7个循环子系统的公立医院战略绩效管理体系概念框架。     

卫生筹资与卫生系统绩效之间的关系及对中国的启示研究

目的:探索卫生筹资对卫生系统绩效的影响,为筹资模式的设计提供依据.方法:以经济合作发展组织(OECD)29个国家为研究样本,将其筹资模式分为税收与社会保险筹资两种方式,采用多元线性回归模型,构建卫生筹资模式及有关变量与卫生系统绩效间的回归模型.结果:税收筹资模式国家的卫生系统绩效总体优于社会保险模式的国家.政府卫生投入、卫生支出、GDP等筹资指标与卫生系统绩效正向相关.结论:税收筹资模式能更好地改善卫生系统绩效.中国卫生筹资应优先考虑税收筹资制度.     

卫生监督机构绩效管理指标设置的探索与思考

绩效管理指标是绩效管理具体内容的表达,制定绩效管理指标是开展绩效管理的基础性工作。作者介绍了上海市卫生局卫生监督所绩效管理指标的分类和制定思路,并就制定过程总结了一些探索经验,即指标制定需要兼顾全面性和精炼性、指标制定必须考虑有效性和操作性、指标制定能够推动管理制度的健全、指标制定应实行分类管理、对于临时工作建立动态处理机制。     

评价卫生系统绩效的新框架——介绍2000年世界卫生报告

本文介绍了２０００年世界卫生报告的主要内容及其出台的背景。ＷＨＯ在该报告中提出了一个分析国家卫生系统的新框架。卫生系统应有三个主要目标和四个主要功能用以判别卫生系统的工作绩效,并创造了一个“绩效指数”来进行各国间的比较研究。     

公共卫生体系绩效评估的概念性框架

文章提出了一个评估公共卫生系统绩效的概念性框架,该框架将整个系统分为全国、地区两个层次,以Donabedian的理论为基础,将系统目标与持续性质量改善模式中的结构、过程、产出和结果及外部环境5个部分联系在一起.该评估框架可以用来监测公共卫生系统、具体的机构及项目的绩效.尽管目前测量公共卫生系统绩效还存在一定的困难,但相信随着评估技术的不断改进,公共卫生系统的绩效将会得以改善,最终改善人群的健康状况.     

Waste in the U.S. Health Care System: A Conceptual Framework

Context: Health care costs in the United States are much higher than those in industrial countries with similar or better health system performance. Wasteful spending has many undesirable consequences that could be alleviated through waste reduction. This article proposes a conceptual framework to guide researchers and policymakers in evaluating waste, implementing waste‐reduction strategies, and reducing the burden of unnecessary health care spending. Methods: This article divides health care waste into administrative, operational, and clinical waste and provides an overview of each. It explains how researchers have used both high‐level and sector‐ or procedure‐specific comparisons to quantify such waste, and it discusses examples and challenges in both waste measurement and waste reduction. Findings: Waste is caused by factors such as health insurance and medical uncertainties that encourage the production of inefficient and low‐value services. Various efforts to reduce such waste have encountered challenges, such as the high costs of initial investment, unintended administrative complexities, and trade‐offs among patients', payers', and providers' interests. While categorizing waste may help identify and measure general types and sources of waste, successful reduction strategies must integrate the administrative, operational, and clinical components of care, and proceed by identifying goals, changing systemic incentives, and making specific process improvements. Conclusions: Classifying, identifying, and measuring waste elucidate its causes, clarify systemic goals, and specify potential health care reforms that—by improving the market for health insurance and health care—will generate incentives for better efficiency and thus ultimately decrease waste in the U.S. health care system.     

Changing Mental Health Gatekeeping: Effects on Performance Indicators

This study evaluated how a change in gatekeeping model at a health maintenance organization affected performance indicators for specialty outpatient mental health care. Gatekeeping in one division changed from in-person evaluations to a call center with routine authorization for the first eight visits. Using 1996–1999 claims data (including 2 years pre- and 2 years postintervention), the study compared performance indicator results in the affected division and another where the model did not change. Subjects included 122,751 continuously enrolled persons. Dependent variables were mental health emergency room use, treatment initiation, treatment engagement, and family treatment for child patients. After controlling for secular trends at the other division and enrollee characteristics, the division that changed gatekeeping experienced no significant impact on most indicators and an increase in family treatment for children. The move to call-center gatekeeping did not appear to have a negative impact on treatment process as reflected in these indicators.     

A Conceptual Framework for Life-Cycle Health Technology Assessment

ObjectivesHealth technology assessment (HTA) uses evidence appraisal and synthesis with economic evaluation to inform adoption decisions. Standard HTA processes sometimes struggle to (1) support decisions that involve significant uncertainty and (2) encourage continued generation of and adaptation to new evidence. We propose the life-cycle (LC)-HTA framework, addressing these challenges by providing additional tools to decision makers and improving outcomes for all stakeholders.MethodsUnder the LC-HTA framework, HTA processes align to LC management. LC-HTA introduces changes in HTA methods to minimize analytic time while optimizing decision certainty. Where decision uncertainty exists, we recommend risk-based pricing and research-oriented managed access (ROMA). Contractual procurement agreements define the terms of reassessment and provide additional decision options to HTA agencies. LC-HTA extends value-of-information methods to inform ROMA agreements, leveraging routine, administrative data, and registries to reduce uncertainty.ResultsLC-HTA enables the adoption of high-value high-risk innovations while improving health system sustainability through risk-sharing and reducing uncertainty. Responsiveness to evolving evidence is improved through contractually embedded decision rules to simplify reassessment. ROMA allows conditional adoption to obtain additional information, with confidence that the net value of that adoption decision is positive.ConclusionsThe LC-HTA framework improves outcomes for patients, sponsors, and payers. Patients benefit through earlier access to new technologies. Payers increase the value of the technologies they invest in and gain mechanisms to review investments. Sponsors benefit through greater certainty in outcomes related to their investment, swifter access to markets, and greater opportunities to demonstrate value.     

Better Measurement for Performance Improvement in Low‐ and Middle‐Income Countries: The Primary Health Care Performance Initiative (PHCPI) Experience of Conceptual Framework Development and Indicator Selection

Policy Points:

• Strengthening accountability through better measurement and reporting is vital to ensure progress in improving quality primary health care (PHC) systems and achieving universal health coverage (UHC).
• The Primary Health Care Performance Initiative (PHCPI) provides national decision makers and global stakeholders with opportunities to benchmark and accelerate performance improvement through better performance measurement.
• Results from the initial PHC performance assessments in low‐ and middle‐income countries (LMICs) are helping guide PHC reforms and investments and improve the PHCPI's instruments and indicators. Findings from future assessment activities will further amplify cross‐country comparisons and peer learning to improve PHC.
• New indicators and sources of data are needed to better understand PHC system performance in LMICs.

Context

The Primary Health Care Performance Initiative (PHCPI), a collaboration between the Bill and Melinda Gates Foundation, The World Bank, and the World Health Organization, in partnership with Ariadne Labs and Results for Development, was launched in 2015 with the aim of catalyzing improvements in primary health care (PHC) systems in 135 low‐ and middle‐income countries (LMICs), in order to accelerate progress toward universal health coverage. Through more comprehensive and actionable measurement of quality PHC, the PHCPI stimulates peer learning among LMICs and informs decision makers to guide PHC investments and reforms. Instruments for performance assessment and improvement are in development; to date, a conceptual framework and 2 sets of performance indicators have been released.

Methods

The PHCPI team developed the conceptual framework through literature reviews and consultations with an advisory committee of international experts. We generated 2 sets of performance indicators selected from a literature review of relevant indicators, cross‐referenced against indicators available from international sources, and evaluated through 2 separate modified Delphi processes, consisting of online surveys and in‐person facilitated discussions with experts.

Findings

The PHCPI conceptual framework builds on the current understanding of PHC system performance through an expanded emphasis on the role of service delivery. The first set of performance indicators, 36 Vital Signs, facilitates comparisons across countries and over time. The second set, 56 Diagnostic Indicators, elucidates underlying drivers of performance. Key challenges include a lack of available data for several indicators and a lack of validated indicators for important dimensions of quality PHC.

Conclusions

The availability of data is critical to assessing PHC performance, particularly patient experience and quality of care. The PHCPI will continue to develop and test additional performance assessment instruments, including composite indices and national performance dashboards. Through country engagement, the PHCPI will further refine its instruments and engage with governments to better design and finance primary health care reforms.     

A Framework for the Development of MaternalQuality of Care Indicators

Background: In collaboration with the California Department of Health Maternal and Child Health Branch, the authors formed a Working Group to identify potential clinical indicators that could be used to inform decision making regarding maternal health care quality. Objective: To develop potential indicators for the assessment of maternal health care quality. Materials and Methods: A Working Group was convened to review information from the published literature and expert opinion. Selection of potential indicators was guided by the following goals: 1) To identify key areas for routine aggregate monitoring; 2) To include perspectives of relevant stakeholders in maternal health care services; 3) To include measures that are comprehensive and reflect a balance between maternal and fetal interests; and 4) To develop measures that would be valid, generalizable, mutable, and feasible. Results: Ninety potential indicators were identified. Each underwent a thorough review based on: its definition, objective, and validity; its contribution to innovation; the cost and timeliness of implementation; its feasibility, acceptability, and potential effectiveness; and its compatibility with ethics, values, and social policy. This process yielded 24 final indicators from the following categories: Health Status and Access (e.g., availability of 24 h inpatient anesthesia); Preconception and Interconception Care (e.g., Pap smear use); Antenatal Care (e.g., hospitalization for uncontrolled diabetes or pyelonephritis); Labor and Delivery Care (e.g., chorioamnionitis or obstetrical hemorrhage), and Postpartum Care (e.g., rate of postpartum visits). Conclusions: These potential indicators, representative of the women's health continuum, can serve as a foundation to structure the development of consensus and methods for maternal health care quality assessment.     

锦州地区部分中学生健康需求的现状与对策

目的 了解青少年健康意识和健康需求现状，探索开展青少年健康教育的对策。方法 以整群抽样的方法选取锦州市2所中学1300名学生，采用自行设计的调查问卷，以班为单位进行集体调查。结果 男女生中分别有82．7％和90．0％的学生了解健康概念，分别有1．6％和4．3％的学生不知道健康的概念。80．1％的学生认为心理健康问题是最主要的健康问题。66．4％的学生需要心理卫生等知识。结论 社会、学校、家庭要根据中学生的年龄特征和性别特点开展健康教育和保健服务。     

The Meaning of Quality in Health Care: A Conceptual Analysis

During the past three decades, there has been an ongoing debate on the quality of health care. Defining quality is an important part of it. This paper offers a review of definitions and a conceptual analysis in order to understand and explain the differences between them. The analysis results in a semantic rule, expressing the meaning of quality as an optimal balance between possibilities realised and a framework of norms and values. This rule is postulated as a formal criterion of meaning, e.g. when (correctly) applied people understand each other. The rule suits the abstract nature of the term "quality." Quality doesn't exist as such. It is constructed in an interaction between people. This interaction is guided by rules in order to transfer information, e.g. communicate on quality. The rule improves our ability to discuss the debate on quality and to develop a theory grounding actions such as quality assurance or quality improvement.