子宫肌瘤单病种住院费用

正单病种付费是指通过统一的疾病诊断分类,科学地制定出每一种疾病的定额偿付标准,社保机构按照该标准及住院人次向定点医疗机构支付住院费用,参保人员在出院时按规定交纳自付额及不列入病种费用支付额的医疗服务费用。单病种付费制度能够有效控制医疗费用过快增长,提高医院的工作效率[1-4];但随着医疗技术水平的不断进步和医疗成本的不断提高,单病种付费制度也会使医疗机构面临收益风险,甚至给医疗机构正常     

医疗费用支付方式利弊分析

本文对五种常用医疗费用支付方式对激励及约束医疗服务提供者的行为、控制医疗费用、调节医疗资源配置、促进医疗质量提高等方面的不同作用进行了比较分析，作者认为采用适合当地情况，以单元付费、人头付费、病种付费、总额预算等多种付费方式并存的复合式支付方式可实现医、保、患三方共赢的目的，将是今后研究、发展的方向。     

医保总额预付制对医疗机构经济运营的影响初探

医药卫生体制的改革包括费用支付方式的改革,其主要目的是提高医疗服务质量,控制不合理费用和改善医院的绩效。医疗机构力争以尽可能低的成本为病人提供高质量的医疗服务,因此要做到既有效益又有效率,才能满足不断降低医疗费用支出的目的。近几年来,我国医疗机构费用支付方式的研究在理论上有了很     

国内外护理院付费方式现况及启示

<正>随着医疗费用在世界各国的迅猛上涨,控制医疗费用的增长成为各国政府面临的最为重要和紧迫的难题。医疗支付方式的改革备受各国政府的重视,成为卫生改革的关键环节之一[1]。预付制和后付制是两大基本支付方式,预付制主要包括按总支出额付费、按人头付费、按病种付费3种形式;后付制包括按服务项目付费、按服务单元付费[2]。护理     

参加医疗保险骨折患者住院费用影响因素分析

目的了解影响参加医疗保险骨折患者住院费用的主要因素，为控制医疗费用的不合理增长和改革医疗保险支付方式提供参考。方法收集济南市某医院2006年9月-2007年4月参加城镇职工医疗保险的113例骨折患者全部住院医疗费用情况，采用线性回归分析可能影响住院费用的因素。结果耗材比例、药费比例、住院天数、是否输血等是影响参加医疗保险的骨折患者住院费用的主要因素。结论合理降低耗材比例和药费比例，缩短住院天数，严格手术与输血适应症是控制骨折住院医疗费用过快增长的关键。应加快和深化医疗保险支付方式的改革，制定科学的骨折诊疗规范、临床路径和费用标准，试行某些病种如骨折等按病种付费结算。     

对“按人头付费、工资支付、按项目付费以及混合支付制度对初级保健医生行为的影响”一文的评论

不同支付方式对初级保健医生行为的影响是几乎所有国家（无论怎样的经济发展水平）都关心的问题。近年越来越多的发展中国家采用了多种不同的支付方式代替传统和广泛使用的按项目付费制度。中国卫生服务体系改革过程中采用按项目付费、按诊断相关分类付费（又称按病种付费）、按总额预算付费、按人头付费等支付方式的城镇职工基本医疗保险和农村合作医疗保险方案的数量在逐渐增加。因此，本Cochrane系统评价强调的问题与中国高度相关，在其他发展中国家也如此。     

对“按绩效支付能否改善卫生保健质量”一文的评论

按绩效支付（Pay—for—performance；performance—based payment）是卫生经济学研究和讨论的热门话题，是如何利用有限卫生资源最大程度促进健康产出的重要政策工具。按绩效支付主要侧重两个层面的研究，一是通过支付方式的设计，如采用按病种支付或按人头支付，在明确界定服务费用、质量等产出的基础上，改善资源利用效率；一是对卫生机构或卫生服务提供者个人，实施某种明确的激励措施，如服务合同或奖金，以实现预期产出。     

谈进一步做好高校医疗、预防、保健工作

由于医疗保障制度改革的实施,推动了高校医疗机构的改革,教职工参加医保后,可根据自己的居住地和需求自由地选择定点医疗机构,但高校中的学生尚未实施医疗保障制度改革,学生在校内看病,大部分免费或仅支付很少的费用,因此对学生的医疗服务仍是高校医疗机构进行公益性服务的重要     

2003～2007年某医院市医保住院人数调查及分析

为了控制医疗费用的急剧增长，基本医疗保险基金管理采用“总额控制，定额管理，年度考核”的支付方式，医院面临着严格的收入总量限制，超支不报销，由医院自己承担。这种医疗费用支付方式与补偿机制，要求医院在有效控制医疗费用的同时，提高医疗服务质量，保护医院和患者双方的利益，增加了对医院的压力，对医院在病人医疗费用的有效性和合理性方面的要求就更高了，降低医疗成本和提高医疗质量成为医院医疗管理所面对的主要课题。     

浅谈医院病案管理的重要性

新形势下在医院病案管理中,如何既能保证病案资料的严肃性、真实性和可靠性,又能建立一支高素质的病案管理队伍是保证病案管理质量的关键,特别是随着医保制度的改革和规范化管理,按病种付费将成为患者和医疗保险部门支付医疗费用的主要方式,对疾病分类则成为费用核算支付的重要依据,给疾病和手术分类编码的正确与否将会直接影响医院的经济利益和医保支付,这就对病案管理人员提出了更高的要求。     

Nurses' basic guide to understanding the Medicare PPS.

Nurse leaders grappling with changing reimbursement need to know the background and structure of Medicare's Prospective Payment System. The author explains case mix and Resource Utilization Groups, as well as applications for practice.     

Reflecting the scope and work of palliative care teams today: an action research project to modernise a national minimum data set

The Minimum Data Set (MDS) for UK specialist palliative care services was developed in 1995 to provide annual data on palliative care services. Data collected is used for local and national purposes including service management, monitoring and audit, the commissioning of services and the development of national policy. The emergence of Payment by Results and HealthCare Resource Groups, which will have an impact on the funding processes, together with identified limitations of the current MDS resulted in a project to revise the MDS. An action research approach was used for the project and had distinctive phases including modifying the MDS, a pilot phase and an expert panel consultation. Modifications to all the sections of the MDS and changes to terminology were made. The action research approach enabled revisions made based upon a national consensus and met the changing provision of specialist palliative care services for the UK.     

汶川地震2周2283例急诊伤员分检方案的总结与探讨

目的回顾性分析四川大学华西医院在汶川地震后采取非常规方法（传统分检方法结合灾害救援的特点）分检伤员的效果，为建立大型灾害事件伤员分检处理流程，及时合理配置医疗资源，提高医疗救援水平提供参考。方法以华西医院在震后两周内接诊的所有地震伤员的诊疗信息数据为基础，对伤员伤情严重程度和所需医疗干预的迫切程度进行分检。结果按伤情严重程度和所需医疗干预的迫切程度对伤员进行分检，使危重伤员得到了及时处理，一般伤员得到了足够重视，轻伤员被及时分流，从而充分合理地利用了医疗资源，使各类伤员都得到了最恰当的处理。结论重大灾害事件发生后，伤员分检方法的选择要因地制宜，不应局限于传统的分检方法。采用灾害救援伤员分检方式分检地震后大批伤员，可使重伤员不延误病情，轻伤员不浪费医疗资源，使有限的医疗资源得到充分合理地利用。     

Accounting for care: Healthcare Resource Groups for paediatric critical care

Healthcare Resource Groups are a way of grouping patients in relation to the amount of healthcare resources they consume. They are the basis for implementation of Payment by Results by the Department of Health in England. An expert working group was set up to define a dataset for paediatric critical care that would in turn support the derivation of Healthcare Resource Groups. Three relevant classification systems were identified and tested with data from ten PICUs, including data about diagnoses, number of organ systems supported, interventions and nursing activity. Each PICU provided detailed costing for the financial year 2005/2006. Eighty-three per cent of PICU costs were found to be related to staff costs, with the largest cost being nursing costs. The Nursing Activity Score system was found to be a poor predictor of staff resource use, as was the adult HRG model based on the number of organ systems supported. It was decided to develop the HRGs based on a 'levels of care' approach; 32 data items were defined to support HRG allocation. From October 2007, data have been collected daily to identify the HRGs for each PICU patient and are being used by the Department of Health to estimate reference costs for PICU services. The data can also be used to support improved audit of PICU activity nationally as well as comparison of workload across different units and modelling of staff requirements within a unit.     

Refining DRGs. The example of children's diagnosis-related groups

Congress exempted certain types of specialty hospitals from the Medicare Prospective Payment System because it was recognized that Diagnosis-Related Groups (DRGs) may not properly define the case mixes in such institutions. This study is part of a larger investigation into case mix and payment in children's hospitals, one category of exempted institutions. A national sample of approximately 500,000 cases was developed with intentional oversampling of children's and university hospitals to allow detection of specialized types of cases. Five case-mix classification schemes--DRGs, Disease Staging, Patient Management Categories, Severity of Illness Score, and Pediatric Diagnosis System groups--were applied to the data set, and data items not included in the Uniform Hospital Discharge Data Set were collected. A set of Children's Diagnosis-Related Groups (CDRGs), based on modification of the current DRG system, resulted from the study. When CDRGs were applied to an independent sample of children's hospital data, length of stay variance was reduced by 47.6% compared with 32.3% for DRGs (length of stay outliers removed). These results suggest that incremental approaches to DRG refinement in other clinical areas where current definitions are inadequate may be better than rejecting the large amounts of statistical and clinical analyses existing in the DRG system. Similar methods can be used to correct problems brought on by changes in medical practice.     

新医改后四川省县级及以下医疗机构收支情况分析

目的调查新医改后四川省县级及以下医疗机构的收入和支出的情况,分析各类型医疗机构在新的补偿机制下所面临的问题及解决方法。方法采用文献复习、专家咨询、问卷调查的方法,对医疗机构进行调查,利用SPSS18．0进行统计描述与分析。结果2009—2011年调查医疗机构的总收入年增长率为31．23％,总支出年增长率为32．09％;总收入中财政补助占比不断提升,药品收入占比有下降趋势。县级医疗机构的收支以医疗和药品为主,妇幼保健院政府补助收入占比最高。结论四川省县级及以下医疗机构的收支模式正在发生改变。在新形势下,县级医院可拓宽补偿渠道;乡镇卫生院和社区卫生服务中心可将重心倾向于软实力的提升;妇幼保健院应重视妇幼保健服务的附加作用,实现内部造血。     

致心律失常性右室心肌病的磁共振诊断价值及研究进展

致心律失常性右室心肌病(arrhythmogenic right ventricular cardiomyopathy,ARVC)是一种以脂肪或纤维脂肪进行性替代右室心肌为特征的遗传性心肌病,是青年人和运动员心源性猝死的常见原因。该病不单局限于右室,部分患者左室也有不同程度的受累。目前,ARVC的诊断基于标准修订版(revised task force criteria,rTFC)的多学科综合评估。心脏磁共振是一种理想的、非侵入性的成像技术,它提供了心脏组织学、功能及形态学等信息,在ARVC的早期诊断和定性、定量分析中发挥着重要作用。笔者就心脏磁共振在ARVC的诊断价值及研究进展予以综述。     

2008 refinements to the Medicare Home Health Prospective Payment System

On January 1, 2008, Centers for Medicare and Medicaid Services (CMS) implemented refinements to the Prospective Payment System (PPS). This is the first change to the way CMS reimburses Medicare patients receiving home health services since the inception of PPS in 2000. The calculation for the exact episode payment has changed significantly, but from a clinical management perspective, the focus must be on ensuring that both the Outcome and Assessment Information Set (OASIS) assessment and the International Classification of Diseases (ICD)-9 CM coding are completed accurately-the same things all clinicians should be doing currently! This article will describe the structural, payment adjustment, and base rate changes for Medicare home care reimbursement that were implemented by CMS on January 1, 2008.     

四川大学华西临床医学院医学研究生科研基本情况调查

目的了解四川大学华西临床医学院医学研究生科研现状。方法采用自制的调查表对四川大学华西临床医学院352名医学研究生的科研现状进行调查,并采用SPSS 15.1软件进行统计分析。结果该院医学研究生的实验涉及多种技术,并以分子技术应用为最多,达35.5%;68%的研究生认为临床、教学和科研都非常重要;在科研中遇到最多的问题依次为课题设计、实验技术方法、联系实验室、统计分析;51.1%的研究生遇到问题会求助于导师,40.1%会自己解决。结论应加强对医学研究生科研能力和意识的培养,为医学研究生开展科研提供平台。     

汶川大地震受灾者创伤后应激症状及危险因素

目的:探讨大地震受灾者的心理健康状况、创伤后应激障碍(PTSD)症状及其影响因素,为心理救助及康复提供依据。方法:2008年四川汶川大地震1个月后,采用事件影响量表(IES)、症状自评量表(SCL-90)和受灾情况表对57例受灾者进行创伤后应激障碍症状、情绪障碍及人口学资料调查,根据诊断分为PTSD组与非PTSD组进行对照比较,并与60例医院健康体检人群进行对照比较。结果:①地震受灾组的IES总分、闯入因子、回避因子、警觉性因子、躯体化、抑郁、焦虑和其他项目因子分均高于正常对照组,差异有显著性意义(P<0.01),地震受灾组的SCL-90总分和抑郁因子分高于正常对照组,差异有显著性意义(P<0.05);②PTSD组的教育程度在小学及以下的比例、被困比例和伤残比例均高于非PTSD组,差异有显著性意义(P<0.05),PTSD组的一级亲属死亡比例、无家人支持比例均高于非PTSD组,差异有显著性意义(P<0.01)。结论:地震受灾者灾后1个月存在明显创伤后应激症状、躯体化、抑郁、焦虑、眠差等表现,心理救助和康复较为必要,应重点关注导致伤残、教育程度低、有被困经历、丧失亲人、缺少家庭支持的地震受灾个体。