公立医院医务人员薪酬制度改革目标及分配要素分析

文章阐述了公立医院薪酬制度改革的三个目标：外部公平、内部公平和个人公平,并分析了公立医院薪酬分配需考 量的六个要素院心理压力、教育成本、技能积累、服务复杂性、劳动强度、职业安全。     

上海:医生收入要看患者满意度

记者从2013年7月9日召开的上海市人民政府新闻发布会上获悉,上海以"转机制"作为公立医院改革关键,改变按业务收入提成的内部分配方式,建立基于医务人员绩效考核的收入分配方法 ,将岗位工作量、服务质量、费用控制、患者满意度等作为医务人员收入分配的依据。在下一步的公立医院改革中,上海将通过建立严格有效的监管机制、客观公正的考核评价机制、与绩效挂钩的投入补偿机制、科学规范的收入分配机制,形成正确利益导向,引导公立医院跟着政府的"指     

价值链分析角度下的公立医院运营和资源配置思路分析

本研究立足于我国公立医院运营管理政策演变,从公立医院价值链分析与传统价值链分析的异同点出发,对公立医院运营和资源配置思路和框架进行分析。价值链分析层面,公立医院需要从医疗服务项目的自主定价权、基本活动与支持活动的界限及权重、公立医院对于收支结余的适用性3个方面进行考虑;与之匹配,医院运营管理和资源配置需要着重关注医疗质量与成本控制的平衡、支持性活动中不同的战略发展任务、围绕结余分配展开的筹融资政策以及医院人力资源与技术开发的经济外部性,构建公立医院基于价值管理的运营管理机制。     

薪酬制度改革：总量与结构

正2021年7月,人力资源和社会保障部、财政部、国家卫生健康委、国家医疗保障局、国家中医药管理局联合印发《关于深化公立医院薪酬制度改革的指导意见》提出,落实"两个允许"要求,实施以增加知识价值为导向的分配政策,建立适应我国医疗行业特点的公立医院薪酬制度,强化公立医院公益属性,调动医院和医务人员积极性,不断提高医疗服务质量和水平,更好地满足群众的医疗服务需要。     

基于有效激励的公立医院职能科室绩效分配模式探讨

目的:构建有效激励的公立医院职能科室绩效分配模式,改变职能科室"激励失效"问题。方法:研究当前公立医院绩效分配制度现状,分析其实际运行中存在的问题,提出改进对策。结果:从公立医院现有绩效分配制度来看,其基础性绩效与奖励性绩效的考核与分配,因考核目标难以明确、考核方式单一等问题,出现了激励失效问题,导致了职能科室"大锅饭"现象,严重压抑了行政人员的主动性和创造性。结论:通过专业技术职称和行政职务的并轨管理、科学合理设定目标基础上的分级管理制度和鼓励管理创新机制三个措施的确立,可以有效化解公立医院职能科室绩效分配的激励失效问题。     

以公益性为导向的公立医院改革内涵认识与实践

公益性导向是公立医院改革的核心要求。深刻把握公立医院公益性内涵认识, 关系到深化以公益性为导向的公立医院改革实施效果。作者回顾梳理了以公益性为导向的公立医院改革历史演进过程, 总结凝练出公立医院公益性核心内涵, 包括"法定义务、系统观念、人民立场、普惠目标", 并介绍了华中科技大学同济医学院附属协和医院基于此内涵认识, 开展的以"党的建设、医疗技术、卫生应急、改善服务、薪酬分配、经济运营、资源扩容与下沉"等为重点的深化公立医院公益性改革实践。     

公立医院对外合作的法律风险及对策研究

通过研究《基本医疗卫生与健康促进法》第39条、第40条,发现条文中"变相分配收益"概念边界不明,"医疗卫生机构"概念与相关法规中的概念界定存在冲突。由此可能滋生违法风险,特别是特许经营、托管、服务外包、共建病理、影像、检验中心、SPD等合作模式,有可能出现变相分配收益、科室承包、出借资质等违法现象。为确保公立医院合法开展对外合作,回应以政府主导、公益性主导、公立医院主导为目标的公立医院高质量发展要求,应明晰公立医院对外合作相关概念的范围。遵循风险预防原则,公立医院对外合作模式按风险等级分类进行审批备案。确立各对外合作模式的合法性标准,并完善法律责任体系,遵循法不溯及既往原则处理合法性存疑的存量合作项目。     

公立医院绩效薪酬分配体系改革探讨

为了适应新医改政策,推进公立医院薪酬改革的关键环节,医院在推进全成本核算的基础上,对医院绩效考核、薪酬分配体系进行结构调整及流程改进,将改革进程中遇到的难点问题运用管理工具进行信息化管控。本文探讨绩效考核的评价机制、薪酬结构的合理设定、薪酬水平的合理确定、薪酬分配的监管机制,为推进公立医院绩效、薪酬分配制度改革积累经验。     

公立医院高质量发展在“质”不在“量”

正在抗击新冠肺炎疫情的战役中,中国成绩非常亮眼,在全球可圈可点。这得益于我国政治体制优势,也得益于多年来公立医院改革发展积累下来的厚实"家底"。新时期,我国公立医院要实现高质量发展,关键在"质",不在"量"。其中,三级公立医院绩效考核,正是引领加强医院内涵建设的"指挥棒"之一。因此,公立医院应理性看待绩效考核成绩,不必过于纠结排名,     

论取消药品加成对公立医院的影响

分析了取消"药品加成"使公立医院面临的困境和可获得的补偿途径;提出了公立医院对于新财政补偿机制实施的难点,如"技术服务费"难以提高、药事服务费的收取和分配难以确定、医院全成本核算体系不健全和政府对公立医院的财政补偿标准难以衡量,并进行了相关探讨,为进一步规范和完善对公立医院的财政补偿机制提供了参考依据.     

S4HARA: System for HIV/AIDS resource allocation

Background

HIV/AIDS resource allocation decisions are influenced by political, social, ethical and other factors that are difficult to quantify. Consequently, quantitative models of HIV/AIDS resource allocation have had limited impact on actual spending decisions. We propose a decision-support System for HIV/AIDS Resource Allocation (S4HARA) that takes into consideration both principles of efficient resource allocation and the role of non-quantifiable influences on the decision-making process for resource allocation.

Methods

S4HARA is a four-step spreadsheet-based model. The first step serves to identify the factors currently influencing HIV/AIDS allocation decisions. The second step consists of prioritizing HIV/AIDS interventions. The third step involves allocating the budget to the HIV/AIDS interventions using a rational approach. Decision-makers can select from several rational models of resource allocation depending on availability of data and level of complexity. The last step combines the results of the first and third steps to highlight the influencing factors that act as barriers or facilitators to the results suggested by the rational resource allocation approach. Actionable recommendations are then made to improve the allocation. We illustrate S4HARA in the context of a primary healthcare clinic in South Africa.

Results

The clinic offers six types of HIV/AIDS interventions and spends US$750,000 annually on these programs. Current allocation decisions are influenced by donors, NGOs and the government as well as by ethical and religious factors. Without additional funding, an optimal allocation of the total budget suggests that the portion allotted to condom distribution be increased from 1% to 15% and the portion allotted to prevention and treatment of opportunistic infections be increased from 43% to 71%, while allocation to other interventions should decrease.

Conclusion

Condom uptake at the clinic should be increased by changing the condom distribution policy from a pull system to a push system. NGOs and donors promoting antiretroviral programs at the clinic should be sensitized to the results of the model and urged to invest in wellness programs aimed at the prevention and treatment of opportunistic infections. S4HARA differentiates itself from other decision support tools by providing rational HIV/AIDS resource allocation capabilities as well as consideration of the realities facing authorities in their decision-making process.     

Recommendations for increasing the use of HIV/AIDS resource allocation models

Background

Resource allocation models have not had a substantial impact on HIV/AIDS resource allocation decisions in spite of the important, additional insights they may provide. In this paper, we highlight six difficulties often encountered in attempts to implement such models in policy settings; these are: model complexity, data requirements, multiple stakeholders, funding issues, and political and ethical considerations. We then make recommendations as to how each of these difficulties may be overcome.

Results

To ensure that models can inform the actual decision, modellers should understand the environment in which decision-makers operate, including full knowledge of the stakeholders' key issues and requirements. HIV/AIDS resource allocation model formulations should be contextualized and sensitive to societal concerns and decision-makers' realities. Modellers should provide the required education and training materials in order for decision-makers to be reasonably well versed in understanding the capabilities, power and limitations of the model.

Conclusion

This paper addresses the issue of knowledge translation from the established resource allocation modelling expertise in the academic realm to that of policymaking.

     

The necessary frugality of the elderly

The purpose of this article is to reflect on the pertinence and moral legitimacy of basing the allocation of public resources for health on the age variable, considered from the perspective of the theory of "justice as equity" as formulated by John Rawls. After characterizing the problem of public resource allocation for health -- confronted with the challenge posed by population aging -- and briefly presenting the concept of equity adopted in this study, as well as discussing the approach by Norman Daniels and Daniel Callahan to resource allocation among different age groups, we conclude that basing resource allocation on the age variable may be considered ethically adequate if we conceive the individual's life as a limited cycle of existence formed by different stages (childhood, adolescence, maturity, old age, and death), during which the needs vary, such that the distribution of resources among different age groups should be based on an ethics of protection.     

基于妇保资源配置的京沪资源优先配置落实情况

目的分析京沪两地经济环境支撑健康优先战略妇保领域资源配置的落实程度,比较其差异并论证其重要意义。方法系统收集京沪两地所有涉及妇保工作的政策文献,量化分析资源优先配置的"制度保障程度""职责明确程度""职责落实程度",以及"落实健康战略的奖惩程度"和"社会经济对公众健康投入程度"等,分析京沪两地经济环境对健康优先战略妇保领域资源配置的支撑程度。结果两地健康战略资源优先配置的制度保障程度均为75%、资源保障部门的职责明确程度均为0%、资源保障部门的职责落实程度均为50%、落实健康战略的奖惩程度均为0%、社会经济对公众健康投入程度上海市和北京市分别为49.1%和74.6%,总体上经济环境对健康战略资源配置总体支撑程度上海市和北京市分别为42.1%和54.8%,健康战略中等水平影响两地资源优先配置的落实程度。结论适宜的妇保体系应围绕健康战略对资源配置形成优先投入的制度保障,并根据职责分工落实所需的资源。北京市健康战略资源优先配置的落实程度略高于上海,但两地仍需围绕健康战略强化落实。     

对县域医改有关问题的思考

我国有些县的医疗改革缺乏全面统筹规划,不能有效地协调联动,致使县域卫生事业发展不平衡,卫生资源配置不合理,医疗卫生结构不协调。因此,县域医改一是要全面统筹规划,坚持整体发展,进行整体协调改革;二是要解决基础定位该怎么定的问题,资金从何处筹集、人员往何处去等关键问题;三是要打破以药养医,坚持公益性质,建立医改的保障机制,明确主体责任机制,坚持政策配套,投入常态机制和医技养医机制。     

2004年全国新型农村合作医疗资金使用情况分析

目的分析2004年全国新型农村合作医疗资金使用与分布是否合理。方法利用卫生部2004年全国新型农村合作医疗资金使用与分布统计数据,对农村合作医疗资金使用等指标进行可比性分析。结果全国93．03％的农村合作医疗资金支出用于住院和门诊费用的补偿,但支出总额仅占筹资总额的65．78％,资金结余过多;每千参合农民住院补偿平均28次,门诊补偿平均519次;农民补偿比例较低,补偿资金流向不够合理。结论资金使用应符合“住院补偿为主、门诊补偿为辅”的原则,避免过多资金的结余。要将资金最大限度地用于农民,合理引导分流病人,控制医疗费用,提高新型农村合作医疗资金使用效率。     

成本-效率原则下构建区域医疗设备共享平台的探索

近年来,我国医疗设备不断推陈出新,种类逐渐增多,但在使用上却呈现部分医疗机构设备闲置过剩和设备紧缺的两级分化状态。为节约成本,整合医疗资源,提高医疗设备的使用效率和服务空间,文章以北京朝阳医院为例,就医院所在区域医疗设备的整合进行探索,并结合共享医疗资源遇到的实际困难提出相应对策。首先,细化医院医疗设备资源分配流程,结合实际选择适合共享的设备,达到控制医疗资源成本的效果。其次,按照政府投入的医疗设备进行有效调配,达到整合资源、分配均衡等效果。最后,希望通过北京朝阳医院医疗设备整合的经验,为区域医疗设备共享提供参考。     

卫生领域中的公平性和筹资公平性

卫生服务中的“公平性”不同于“平等”,它包括卫生服务资源分配的公平、卫生服务利用的公平和卫生服务筹资的公平。而卫生服务的筹资其实是社会再分配体系的一部分,它的含义主要受功利主义观点的影响,即效用最大化理论。要达到卫生服务筹资的公平性,则必须满足3条原则。     

山东省妇幼保健资源配置现状与公平性分析

[目的]分析2012-2017年山东省妇幼保健资源配置现状及其变化趋势,为进一步优化妇幼保健资源配置提供对策建议。[方法]对2012-2017年山东省妇幼保健资源的相关数据进行描述性统计分析,并采用基尼系数和泰尔指数分析和评价山东省妇幼保健资源配置的公平性。[结果]山东省妇幼保健资源总量呈逐年增长趋势;按人口和按地理配置的基尼系数均在0.3以下;区域内妇幼保健机构、机构床位数、医师数及护士数配置上的差异对总泰尔指数的贡献率远高于区域间差异对总泰尔指数的贡献率。[结论]山东省妇幼保健资源总量稳步增加,按人口和地理配置的公平性较高,区域内差异对妇幼保健资源配置的公平性影响较大。建议卫生行政部门应高度重视,统筹兼顾,进一步优化资源配置,加强人才队伍建设,通过"互联网+医疗健康"信息化平台建设,改善妇幼保健资源配置不公平现状。     

与转化医学有关的临床研究质量及研究报告质量的评价工具

客观、公正的临床研究是对实验室研究产物临床有效性评价的主要方法,转化医学的发展有赖于高质量的临床研究,也和研究报告的科学表达有关.临床研究质量与研究报告质量虽然在定义上有所不同,但在科学诚信的环境下,两者密切相关,在绝大多数情况下是一致.论文报告质量可从论文外部特征和内部特征进行初步评价.随机研究可采用Jadad量表及Cochrane偏倚风险评价工具等评价,非随机研究可采用偏倚风险评价工具及Newcastle-Ottawa量表等评价.由于Jadad量表存在缺乏隐蔽分组的评估及对盲法评估简单等问题,所以必须增加隐蔽分组的评估.对于随机对照研究的质量,采用Jadad量表结合Schulz隐蔽分组来评价在当前是被国内外主流期刊接受的一组可行的方法.对于非随机研究的队列研究及病例对照研究,采用Newcastle-Ottawa量表评价可能较为合适.

Abstract：

Objective and fair clinical trials are the main methods for assessing the clinical significances of the experimental findings. The development of translational medicine highly relies on high-quality clinical trials as well as trial reports. Although the definition of"quality of clinical trials"and"quality of trial reports"differs from each other, they are closely related and can be consistent in most circumstance in the context of"scientific integrity". The quality of trial reports can be basically assessed by their internal and external properties. The quality of a randomized trial can be assessed by Jadad scale and Cochrane collaboration's tool for assessing risk of bias, and the quality of a non-randomized trial by risk of bias tool and Newcastle-Ottawa scale. However, since Jadad scale lacks appropriate appraisal of allocation concealment and is too simple in evaluating blind method, assessment of allocation concealment should be added. A more widely accepted approach for assessing the quality of random trials is the combination of Jadad scale and Schulz's approach to allocation concealment till recent years.For non-randomized cohort studies and case-control studies, Newcastle-Ottawa scale might be suitable at present time.