新时期军队医院建设发展的问题与对策

本文对新时期军队医院存在的问题进行分析,通过强化科技创新、强化管理效益、强化医院经营和抓好卫勤战备训练等措施,提高军队医院的创新发展力、市场竞争力和综合保障力。     

医院文化创设

企业把其企业文化视之为企业之魂,商业将其商业文化尊为经营之道,医院文化是医院群体形象的缩影,是物质和精神的结合物。从管理学的角度来说,要抓好医院管理的关键是抓好“两本管理”,即人本管理和成本管理,就是要坚持“两手抓”,一手抓人的工作,充分调动广大群众的积极性、主动性和创造性,一手抓财物管理,充分发挥资本的纽带作用,提高质量,降本增效。     

市场经济体制下的医院经营之道

医院面对其置身医疗市场的现实,应慎重决策,认真管理;以病人需求为导向,注意经营效益;抓大不放小,实行低成本扩张战略;采取开展高新和适应技术,改善环境,加强成本核算,提高服务质量,拓宽医疗市场途径,争取医疗市场份额;抓好急危重症抢救、介入治疗、微创手术、器官移植四在技术,提高技术水平和医疗质量。同时,医院还要重视抓好机构改革、干部管理、人才管理,处理好发展与稳定的关系。     

坚持创新 突出质量 促进医院建设又好又快发展

本文就地处边疆地区的军队小医院，适应市场、保障战场抓好医院建设的做法，提出完善制度，理顺机制，提高医院管理水平，夯实基础，发展特色、提升医院专科建设的整体发展思路，取得了较好的成绩。     

专科医院门诊管理模式探讨

门诊是医院的窗口,集中体现医院的管理水平、技术水平和服务水平。如何抓好门诊的管理,树立医院对外形象,不断吸引病人,扩大医疗市场,打造服务品牌,一直是各医院努力研究的课题。我院是一所三级甲等妇女儿童医疗保健专科医院,     

基层以医院感染管理调查分析

调查２４所医院感染管理工作中的组织落实措施、卫生学监测、卫生学管理等情况，提出几点意见；领导重视是抓好医院感染管理工作的关键；各科室间相互配合，齐抓共管是抓好医院感染管理工作的重要保证。制度的建立，措施贯彻、落实是抓好医院感染管理工作的手段；设立专职人员，是抓好医院感染管理工作的必备条件。     

企业医院应努力加强内涵建设

社会主义市场经济体制的进一步健全和完善,不仅为我国企业医院的建设和发展创造了机遇,同时也使企业医院面临更加严峻的挑战。如何主动适应这一形势需要,积极探讨企业医院在市场经济体制下的生存与发展,已成为企业医院管理者研究的新课题。我院做为中国石油天然气总公司的中心医院,近几年来,坚持以医院分级管理标准为目标,抓好内涵建设,加大科学管理的力度,积极推进两个文明建设,使医院的两个效益、职工的综合素质和医院的整体服务功能都实现了历史性的跨越,取得了显著的成效。     

基层医院感染管理调查分析

调查２４所医院感染管理工作中的组织落实措施、卫生学监测、卫生学管理等情况，提出几点意见：领导重视是抓好医院感染管理工作的关键；各科室间相互配合，齐抓共管是抓好医院感染管理工作的重要保证。制度的建立，措施贯彻、落实是抓好医院感染管理工作的手段；设立专职人员，是抓好医院感染管理工作的必备条件。     

浅谈当前医院的营销策略

一、医院营销策略的提出医院不同于一般企业，医院在市场中具有专业性、垄断性、直接性特征，而医疗消费者──病人，却具被动性、不确定性。因此，借鉴企业的营销经验时，要充分考虑医疗市场的特殊性，不断在实践中总结出医疗市场的固有规律。二、医院在医疗服务市场的营销策略（一）医疗眼务就是医院的产品，开发医疗技术是占领医疗市场的基础。医疗服务对医院来说，相当于企业的产品，而任何经营成功的企业首先都是由于产品开发的成功，医院也只有不断开发出先进的医疗服务，才能提高竞争能力，增加经济效益。１、创新战略医院在医疗技术…     

军队医院体制编制调整后人才队伍建设对策

随着军队体制编制改革的具体实施,军队医院现役干部将越来越少,人才流失不可避免,而现代医院的竞争,归根到底是人才的竞争[1],人才是医院服务质量的保证,是医院可持续发展的关键。为了确保编制调整后医院能继续在医疗市场中保持优势,就必须占领人力资源这一制高点,既要重点抓好     

我国企业医院社会化的理性思考

企业医院是在计划经济时期特定的历史条件下企业自办的医疗机构,为保障企业职工身体健康、为国家现代化建设做出过贡献。随着社会的变革,企业要建立现代企业制度必须剥离社会职能。因而,企业医院从企业中分离乃大势所趋,但又需一个较长的过程。应积极探索适合中国国情的企业医院社会化的多种途径。     

The effects of multi-hospital systems on hospital prices

US hospital prices are rising again after years of limited growth. We analyze trends in hospital prices during a period of significant price growth (1999-2003) to assess whether hospitals that are part of multi-hospital systems were able to increase their prices faster than non-system hospitals. We find hospitals that were members of multi-hospital systems were able to increase their prices substantially more than comparable non-systems hospitals (34% for large systems and 17% for small systems). Further, we find that the systems effect is not confined to hospitals that have other system member hospitals in their local markets. One possible explanation is that hospitals belonging to non-local multi-hospital systems have improved their bargaining position vis-à-vis health plans.     

再论城市大医院的功能定位

实现城市大医院的功能定位,必须立足于我国正处于社会主义初级阶段这一现实。即我国人口多,患者基数大;底子薄,国家对卫生事业投入不足;地区间经济发展不平衡;管理体制不健全,人员素质不高,还要健康地把握当前,恰当地筹划未来。即实事求是,因地制宜,逐步完善,渐进到位。实现城市大医院的功能定位,必须遵循“持续、协调、健康”的发展方针。     

Do rural hospitals lag behind urban hospitals in addressing community health needs? An analysis of recent trends in US community hospitals

Objective:  This study examined whether rural and urban hospitals differ in their level of responsiveness to community health needs.
Design:  This study used a multivariate, longitudinal research design.
Research setting:  A cross-sectional survey was the setting for this study.
Participants:  The participants were rural or urban hospitals in the United States.
Main outcome measures:  The dependent variables were selected from the American Hospital Association hospital survey questions that are related to community health needs. The independent variable was rural or urban location.
Results:  Rural hospitals improved more than urban hospitals in addressing community health needs from 1997 through 2006 for most of the indicators, especially in working with other providers to conduct a community health assessment. However, rural hospitals still lag significantly behind urban hospitals in tracking health information.
Conclusions:  This study suggests that rural hospitals do not lag behind urban hospitals in addressing community health needs. Further research is needed to understand the role of community hospitals in influencing local health delivery system activities regarding the potential community benefits and their impact on improving health of local populations.     

Population characteristics of markets of safety-net and non-safety-net hospitals

Research Objectives To compare and contrast the markets of urban safety-net (USN) hospitals with the markets of other urban hospitals. Study Design To develop profiles of the actual inpatient markets of hospitals, we linked 1994 patient-level information from hospital discharge abstracts from nine states with 1990 data at the ZIP code level from the US Census Bureau. Each hospital's market was characterized by its racial and ethnic composition, median household income, poverty rate, and educational attainment. Measures of hospital competition were also calculated for each hospital. The analysis compared the market profiles of USN hospitals to those of other urban hospitals. We also compared the level of hospital competition and financial status of USN and other urban hospitals. Principal Findings The markets of USN hospitals had higher proportions of racial and ethnic minorities and non-English-speaking residents. Adults residing in markets of USN hospitals were less educated. Families living in markets of USN hospitals had lower incomes and were more likely to be living at or below the federal poverty level. USN hospitals and other urban hospitals faced similar levels of competition and had similar margins. However, USN hospitals were more dependent on Medicare disproportionate share payments and on state and local government subsidies to remain solvent. Conclusion USN hospitals disproportionately serve vulnerable minority and low-income communities that otherwise face financial and cultural barriers to health care. USN hospitals are dependent on the public subsidies they receive from federal, state, and local governments. Public policies and market pressures that affect the viability of USN hospitals place the access to care by vulnerable populations at risk. Public policy that jeopardizes public subsidies places in peril the financial health of these institutions. As Medicare and Medicaid managed care grow, USN hospitals may lose these patient revenues and public subsidies based on their Medicaid and Medicare patient volumes. The loss of these funds would hinder the ability of USN hospitals to finance uncompensated care for uninsured and underinsured patients. An earlier draft of this paper was presented as a poster at the 14th annual meeting of the Association for Health Services Research, Chicago, IL, June 15–17, 1997. Financial support for this research was provided by the Commonwealth Fund. The opinions expressed are solely those of the authors and do not necessarily reflect the positions of Georgetown University and the Commonwealth Fund.     

Updated variable-radius measures of hospital competition

OBJECTIVE: To calculate variable-radius measures of hospital market size and create measures of competition for hospitals' markets. DATA SOURCES: Discharge abstracts from the 1997 State Inpatient Databases of the Healthcare Cost and Utilization Project (HCUP) linked with the American Hospital Association (AHA) Annual Survey, Area Resource File (ARF), InterStudy Regional Market Analysis database, and Medicare's Prospective Payment System Impact Files. STUDY DESIGN: Hospital radii capturing 75 and 90 percent of hospital admissions regressed against hospital and health care market characteristics and other local area characteristics, where the specification was designed to maximize predictive ability. The number of competing hospitals and the Herfindahl-Hirschman index (HHI) of competition were calculated for each hospital's market. DATA COLLECTION METHODS: Discharge abstracts were used to create actual radii for hospitals in nine states. These data were linked with other data describing hospital, health care market, and other characteristics. PRINCIPAL FINDINGS: We explained 44.7 and 9.6 percent of the variation among urban and rural hospitals, respectively, in radii that capture 90 percent of patients, and slightly less of the variation in radii that capture 75 percent of patients. Population density; number of other hospitals in the local area; and hospital characteristics such as medical school affiliation, percentage of admissions that are Medicaid, case mix, and service offerings are important correlates of a hospital's market size. CONCLUSIONS: Predicted radii and associated competition measures were created (matched to AHA hospital identifiers) for all nonfederal, short-term, general medical/surgical hospitals in the continental United States for which complete data were available in 1997 (N=4,806) and are available from the authors.     

State Health Policy and Rural Hospitals

Many rural hospitals are experiencing difficulties. This article explores the views of various government and hospital officials on state health policy for rural hospitals. The authors discuss how these officials define the rural hospital issues and suggest appropriate state interventions to assure hospital viability and local access to care. The authors recommend that states, hospitals, and communities decide through a formal process what level of health and medical care should be available in rural areas, and states assist in low-cost ways those rural hospitals that are ready to change or that, with help, will be ready to make such operational changes as service reconfiguration, affiliations, and working agreements with other health care organizations to continue and improve local access to health care.     

Sole hospital commitment to health promotion and disease prevention (HPDP) services: does ownership matter?

Hospitals have been increasingly involved in health promotion and disease prevention (HPDP) in the last two decades. Concurrent with this trend, environmental changes and market pressures have resulted in more hospital consolidations and conversions from not-for-profit (NFP) to for-profit (FP) organizations. The emergence of a large number of sole community hospitals has attracted the attention of policy-makers and community stakeholders because sole community hospitals have more power in the local market and may discontinue unprofitable services to pursue profit maximization. This may be especially true when the sole hospital is a FP organization. On the other hand, sole community hospitals are confronted with a variety of expectations to offer community-oriented services that promote community population health, regardless of ownership. There is relatively little literature that has attempted to examine the behavior of sole community hospitals. This study depicts the profile of sole hospitals' involvement in HPDP services and estimates the possible influence of community constituencies on hospitals with respect to their providing community-oriented services. The results indicate that typically, when there is only one hospital in the community, hospital ownership has no significant influence on hospital HPDP services than their NPD counterparts. Implications for policy-makers and health care leaders are also discussed.     

Rural Hospitals: Trends, Challenges, and. a Future Research and Policy Analysis Agenda

Previous reviews of the status of rural hospitals conclude that rural hospitals play a major role in ensuring the provision of health services in rural areas, are an essential part of the social and economic identity of rural communities, have had mixed success in their ability to respond to environmental threats, and are very sensitive to public policies due, in part, to their small size. The evolving hospital paradigm in the United States and a turbulent economic and health care environment have created an uncertain future for the rural hospital. Hospitals are being forced to shift their emphasis from filling acute inpatient care beds to providing a more diversified set of services through linkages with other institutions and provider groups. This presents challenges for rural hospitals, which often serve as the foundation for health care delivery in rural communities yet struggle to Overcome the effects of troubled local economies, shortages of health professionals, and public policy inequities. This article reviews key trends and challenges facing rural hospitals from the perspective of their structure and organization, financial sustainability, quality of care provided, and strategic linkages with other entities. It concludes with the presentation of a research and policy analysis agenda that addresses the feasibility of the role of the rural hospital as the hub or coordinator of the rural health care delivery system, the fiscal viability of the rural hospital in the post-Balanced Budget Act period, strategies for measuring and improving the qualify of care provided by rural hospitals, and the structure and value of horizontal and vertical linkages of rural hospitals.     

Hospital–Community Partnerships: Facilitating Communication for Population Health on Columbus’ South Side

Previous studies have focused on the role anchor institutions play in community development. However, less attention has been directed to how hospitals can effectively partner with community-organizations and residents as part of population health efforts. This article examines community views of one initiative developed by a major American children’s hospital in partnership with local community organizations. The data for this study come from 35 in-depth interviews with local residents from the neighborhood adjacent to the hospital and two interviews with hospital administrators. Our findings suggest that the contexts in which hospitals and other non-profit corporations operate pose unique challenges to effective communication. In particular, hospitals and community organizations may think differently about the merits and nature of open communication. Especially when acting as anchor institutions working beyond their formal medical expertise, hospitals may struggle to communicate the scope and goals of their non-medical work in the community.