弋阳县开展医院收支结余审计

医院的收支结余是评价领导业绩的一项综合性经济指标 ,也是评价医院管理好坏的标准之一。弋阳县卫生局根据医院和收支结余核算中的不规范行为 ,有针对性地开展审计 ,其主要采用单一法和合并法。单一法就是按照“业务收支结余”账户函意进行核算 ,即收入包括差额拨款、医疗收入、药品收入、其他收入、制剂收入 ,支出包括医疗支出、药品支出、制剂支出。与此无关的统统剔除。合并法就是把医院的流动资金和专用基金视为一个整体 ,将医疗业务收支结余与专用基金收支结余合并计算。根据医院收支结余核算中的常见问题 ,他们着重注意以下几个方面 :…     

适应形势发展提高军队卫生经济管理和研究水平

国家医疗保障制度改革对卫生经济管理和研究提出了新课题。国家城镇职工基本医疗保险制度和医疗卫生体制改革的总目标是：用比较低廉的费用提供比较优质的医疗服务，努力满足广大人民群众的基本医疗服务需要。为了实现总体目标，必须进行以下改革。一是医疗机构分类管理，分别执行不同的财政，税收和价格政策。国家将医疗机构分为非营利和营利性，逐步形成非营利性医疗机构占主体和主导地位，营利性医疗机构为补充的新的医疗服务体系。二是医药开分核算，医院药品收入实行收支两条线管理。医院对医疗收支，药品收支进行分开核算。医院药品收入扣除药品支出后的纯收入即药品收支结余上缴卫生行政部门，作为财政社会保障基金，经考核后，统筹安排，合理返还。军队，武警医院对社会开放的药品收支结余，按财务隶属关系和属地管理相结合的原则进行管理。     

强化军队医院成本核算管理

军队医院成本核算管理日益为总部职能部门所关注。目前,主要问题有成本核算方法不规范;成本核算内容不全面;成本核算软件研发不完善;成本管理职能部门协调不够;成本核算队伍素质不高。今后医院成本核算管理需要完善的重点是药品管理、物资管理、固定资产管理、制剂生产收支管理、间接费用分摊管理和军队医保人员费用管理。医院成本核算绩效评估需要把握的重点是规范核算制度、软件;规范成本核算方法;规范成本效益指标;掌握效益核算公式和形成能效评估体系。强化医院成本核算管理应处理好:财务管理与经济管理的关系;经济管理职能部门与一线科室之间的关系;军内医疗服务核算与对外医院服务核算的关系;事后成本核算与事前预测、事中控制的关系     

对医院药品收支两条线管理的几点思考

对医院药品收入实行收支两条线管理 ,是城镇医药卫生体制改革的一项重要举措。其目的是为了改变“以药养医”状况 ,控制药品费用的不合理增长 ,促进医院合理用药。但这项政策能否达到预期效果 ,还需我们谨慎思考。一、医院药品收支两条线管理中的困惑１．药品收支两条线管理能否控制药品费用不合理增长。从《医院药品收支两条线管理暂行办法》 (以下简称《办法》)看 ,其内容主要是明确规定执行该办法的单位为“县及县以上的公立非营利性医院” ;药品收支结余要按《医院财务制度》、《医院会计制度》的规定进行核算 ;《办法》管理的对象是药…     

也谈医院药品收支核算管理

当前，医药费用过高已经成为一个引人关注的社会问题，它已经超出了国家、社会和个人的支付能力。国务院体改办等八部门共同制订了《关于城镇医药卫生体制改革的指导意见》，卫生部和财政部也制订了《医院药品收支两条线管理暂行办法》。以上《意见》和《暂行办法》明确规定：实行医药分开核算，分别管理；对医院药品收入实行收支两条线管理，药品收支结余上缴卫生行政部门，统一缴存财政社会保障基金专户管理，经综合管理考核后，统筹安排，合理很环。     

农村卫生院预防保健收支也应实行分开核算、分别管理

邱道尊撰文指出 :在新《医院会计制度》中 ,对乡卫生院开展预防保健收支的归集如何反映没有述及。对此 ,笔者认为 :农村卫生院预防保健收支应在会计核算中单独反映 ,即“分开核算、分别管理”。一、新《医院会计制度》对农村卫生院预防保健收支归集不够明确新《医院会计制度》规定 :“医疗收入”、“医疗支出”是核算医院在开展医疗业务活动中取得的收入和发生的各项费用及摊入的管理费用 ;“药品收入”、“药品支出”是核算医院在医疗业务活动中出售药品取得的收入和药品业务中发生的各项费用及摊入的管理费用。这些业务收支仅指医疗业务方…     

浅谈医药分开核算对医院经济效益的影响

1 对医药分开核算的认识 新的《医院财务制度》和《医院会计制度》中明确规定,医院医疗收支和药品收支分开管理,分别核算。医院药品收入实行核定收入,超收上缴。制度下达后,在医院内部引起了很大反响,归结为两种看法,一是认为会冲击医院收入,影响医院发展;二是认为会降低病人就医成本,增加收入。     

从药品加成率计算失真谈起

在医院业务收入中，药品收入占据相当比例（我区１３家医疗机构１９９５年药品收入占业务总收入６５．７％）。作为考核医院药品收支和资金运动绩效的管理指标有：药品加成率、药品收入比重、药品资金周转率等，其中药品加成率是一项综合反映药品会计管理水平的重要指标。医院药品收支核算涉及诸多环节，如药品采购、药品收费、药房配发、药库管理、药品会计等，因此造成药品加成率计算失真的因素颇多。笔者结合工作实践，择其要点进行剖析。一、影响药品加成率指标的十大因素（一）关于药品会计。医院在采购中西药品的过程中，可以获得数目…     

医院药品收入总额的核定和超收处理

新《医院财务制度》(以下简称“新制度”)对医院药品收支管理作了重要改革。第七条规定:“医院医疗收支和药品收支分开管理,分别核算。“第十六条又规定:“医院药品收入实行‘核定收入、超收上缴’的管理办法。财政和主管部门核定药品收入总额(包括药品成本、加成收入、折扣等各项收入),超出核定部分的收入按规定上缴卫生主管部门。”这对切断医疗机构、医务人员与药品营销之间的利益关系,合理控制医药费用增长,减少卫生资源浪费有着重要的作用。     

医疗机构药品收支两条线检查需注意的几个问题

为加强医院财务管理,规范其经济行为,有效地控制药品费用不合理增长,促进医院合理用药,国家卫生部、财政部于2000年颁布了<医院药品收支两条线管理暂行办法>,明确规定了医院在实行药品收支管理中应遵循的各项制度.但是,我们在实施药品收支两条线管理专项检查中,发现有些医院在药品管理中存在各种各样的违规行为,直接影响了管理制度的实施.我们认为在药品收支管理检查中应注意处理好以下几个问题:     

Men and women: beliefs about cancer and about screening

Background  

Cancer screening programmes in England are publicly-funded. Professionals' beliefs in the public health benefits of screening can conflict with individuals' entitlements to exercise informed judgement over whether or not to participate. The recognition of the importance of individual autonomy in decision making requires greater understanding of the knowledge, attitudes and beliefs upon which people's screening choices are founded. Until recently, the technology available required that cancer screening be confined to women. This study aimed to discover whether male and female perceptions of cancer and of screening differed.     

Thinking about it: thoughts about health and valuing QALYs

When valuing health states (e.g., for use in the assessment of health technologies), health economists often ask respondents how many years of life in poor health they would be willing to trade-off in order to live in full health. Problems with preferences of this kind have led to calls for the use of more direct measures of the utility associated with experiencing a health state. The fact remains, however, that individuals are often willing to make large sacrifices in life expectancy to alleviate conditions for which there appears to be a considerable degree of hedonic adaptation. The purpose of this study is to investigate this important discrepancy in more detail. Data from 1173 internet and telephone surveys in the United States suggest that time trade-off responses are related to the frequency and intensity of negative thoughts about health in ways that may not be very well captured by any of the proposed valuation methods.     

Teenagers' beliefs about AIDS education and physicians' perceptions about them

A survey of 189 Louisiana teenagers and 80 Louisiana family physicians revealed that the teenagers overwhelmingly preferred to learn about acquired immune deficiency syndrome (AIDS) from a physician. This result stimulated an interest in learning whether family physicians shared adolescents' opinions that they are the best teachers for AIDS education and whether family physicians understand adolescents' knowledge and beliefs about AIDS sufficiently well to be effective AIDS educators. Family physicians' responses to a questionnaire based, in part, on the Health Belief Model were compared with teenagers' responses about their knowledge, health beliefs, and preferred format and method of learning about AIDS. Results indicated that family physicians' predictions about teenagers' knowledge and beliefs about AIDS were not always accurate, but, except when physicians underestimated the teenagers' perceived obstacles to AIDS prevention, the data suggested that physicians would be effective in teaching teenagers about AIDS. Family physicians showed good agreement with teens in estimating their desired method and format for learning about AIDS, including their preference for a physician instructor.     

Reflections on the psychoanalytic representations of nurses about themselves and about nursing

This study describes some reflections on the representations of nurses about themselves and about nursing, in order to analyze them within a psychoanalytic framework of the constitution of the subject in the sphere of the desire which motivates them, at the levels of the imaginary and the symbolic. The analysis adopted was the discursive practices proposed by Spink, using association of ideas in the hermeneutical tradition. Considering the subject, eight nurses were interviewed whose interpretations were displayed on graphs and tables. From discourse analysis emerged meanings in the symbolic sphere and the production of meanings. It is possible to understand that the desire of the nurse shows itself as the desire of others' desire, an imaginary desire and therefore, it is imaginary and to be constituted. This object which appears identified with the self, may appear over-valued or commonplace, depreciated or punished. From this point of view, new horizons may open up in practice and professional training for nurses, which brings them together around a signifier which can give them a meaning, enabling them to see themselves as subjects in their professional expressiveness.     

What respondents recall about walking and what self-report items elicit about walking

BACKGROUND: Research on the cognitive processing of survey questions suggests that the distribution of walking bouts (e.g., mean, skew) may influence retrospective self-report responses. METHODS: Undergraduate women (N = 209) kept a weekly log of their walking behavior, then responded to four different self-report measures of walking [National Health Interview Survey (NHIS), Context, Fuzzy-Typical, and Fuzzy-Maximum]. The logs were evaluated to determine which walking characteristics best summarized their walking behavior. Principal components analysis yielded three components of walking behaviors: Frequency, Duration, and Maximum. Multiple regression was used to determine if the walking components differentially predicted the four self-report measures of walking. RESULTS: The Maximum walking component was a significant predictor of all self-report measures of walking. The Context score was also predicted by the Frequency Component. The Frequency and Duration walking components did not predict the NHIS or Fuzzy self-report measures independently of Maximum walking. CONCLUSIONS: Frequency-by-duration self-report measures of walking appear to be more sensitive to the maximum rather than the frequency or duration of walking behavior. Measurement of the frequency of bouts may be best accomplished by providing a framework of recall cues around which walks of different types occur.     

Physician beliefs about victims of spouse abuse and about the physician role

Our purpose was to measure the beliefs of physicians about victims of spouse abuse and to examine factors related to holding positive (e.g., supportive) and negative beliefs about providing services to victims of domestic violence. This was a total site sample of 150 physicians (76 responded; RR 51%), surveyed at one time, practicing in a large general hospital and the surrounding urban/periurban area. Four specialities are represented: emergency medicine, family practice, obstetrics-gynecology, and psychiatry. Three aspects of beliefs are measured: beliefs toward physician role in assisting victims of spouse abuse, beliefs about victims of spouse abuse, and beliefs about resources available to physicians to assist victims of spouse abuse. Almost all (97%) physicians believe it is part of their role to assist victims of domestic violence. Almost one third (30%) hold victim-blaming attitudes toward victims of spouse abuse, and the majority (70%) do not believe that they have the resources available to them to assist victims of domestic violence. Being female, younger, practicing obstetrics-gynecology, and having fewer years in practice are all significantly related to holding supportive (positive) beliefs. The majority of negative beliefs held are about resource availability. Hence, training programs may need to be developed locally for physicians and tailored to individual community characteristics. Training programs should also emphasize the importance of understanding the victims of spouse abuse and of not blaming the victims for the violence.     

Reflexions about aging and work

This qualitative research has the aim to know the meaning of the aging process in the work market referring to the aged people. Six aged persons have participated in this research. The data were collected through an interview and were analyzed using the technique of thematically analyze. Three analytical categories emerged: the meaning of aging/to be aged; the meaning of work; the meaning of aging in the work. Concluding, this paper reinforces the theory that the capitalist societies attach excessive value to the work in the human being life. When it isn't into the life--because of the retirement or the unemployment--it compromises the quality of aging/to be aged of the person, mainly if skills and (individual, social and economical) conditions will lack participation and priority to others activities and values in her/his life.