Benefits of psychosocial oncology care: Improved quality of life and medical cost offset

The burden of cancer in the worldwide context continues to grow, with an increasing number of new cases and deaths each year. A significant proportion of cancer patients at all stages of the disease trajectory will suffer social, emotional and psychological distress as a result of cancer diagnosis and treatment. Psychosocial interventions have proven efficacious for helping patients and families confront the many issues that arise during this difficult time. This paper reviews the literature detailing the extent of distress in patients, the staffing needed to treat such levels of distress, and the efficacy of psychosocial treatments for cancer patients. This is followed by a summary of the literature on medical cost offset in mental health, other medical populations, and in cancer patients, which supports the notion that psychosocial interventions are not only effective, but also economical. Conclusions support taking a whole-person approach, as advocated by a growing number of health care professionals, which would not only help to treat the emotional and social aspects of living with cancer, but also provide considerable long-term cost savings to overburdened health-care systems.     

医用设备的成本管理和成本控制

现代科学技术的成果在医学领域的广泛应用，为人类生存条件的改善和生活质量的提高作出了巨大贡献，但同时也导致了医疗费用的高速上涨。大型医用设备是现代高新技术的突出代表，我国医疗机构在其引进和使用中同样存在着因盲目购置和不合理使用而造成卫生资源浪费的现象。在目前卫生体制改革的背景下，加强对医用设备的成本管理和成本控制，通过控制初始投资规模；合理配置资源和提高设备利用率来提高投资的经济性是非常必要和迫切的。     

Patient medical group continuity and healthcare utilization

Objectives: To measure continuity among medical groups of insured patients over a 5-year period and to test whether group continuity of care is associated with healthcare utilization and costs. Study Design: Retrospective observational study. Methods: We studied natural patient behavior by using insurance claims data in the absence of any medical group or health plan incentives for continuity. We conducted the study through a retrospective analysis of administrative data of 121,780 patients enrolled from 2005 to 2009 in HealthPartners, a large nonprofit Minnesota health plan. Each year, patients were attributed to the medical group where they received the greatest number of primary care visits. Multilevel multiple regression models were used to estimate the association of annualized medical cost and utilization with attribution and continuity categories. Results: Although patients with high medical group continuity were older and had more comorbidities than patients with medium or low continuity of care, they had a consistently lower probability of any inpatient expenditure or any emergency department (ED) utilization and lower total medical costs. Conclusions: Although a small proportion, health plan members who visited a primary care provider but had low or medium continuity among medical groups had higher inpatient and ED use than those with high continuity. Improved coordination and integration has potential to lower utilization and costs in this group.     

跨省异地结算政策对患者就医选择及费用负担的影响——基于北京某肿瘤医院的实证分析

目的:分析跨省异地结算政策对北京大学肿瘤医院住院患者的服务量影响,研究政策对外地患者产生的费用负担差异,评估政策效果,为政策完善提供实证证据。方法:回顾性资料分析,以2017年3月为政策干预起始月,利用间断时间序列回归分析2016年1月—2018年3月间异地政策对住院服务量的变动影响;利用倾向性评分匹配性别、年龄、科室属性、诊断个数及其诊断类别等指标后,评估异地政策对外地患者费用负担的差异影响。结果:改革前后外地人群占比变动了1.70%,但改革的即刻变化和趋势变化的统计学差异都没有显著性,改革当月外地人群出院量当即上涨378.22人次(P>0.1),改革后趋势为每月上涨28.08人次(P>0.1);异地结算之后,实时报销的外地患者比手工报销患者的住院次均费用平均上涨了402.70~726.81元(P>0.1),药占比高出6.47%(P<0.01)。结论:异地结算政策没有显著刺激肿瘤人群跨区域就医和增加患者的直接医疗负担,就医地目录政策可能会使得更多的患者流向宽目录省市。     

医改背景下项目成本核算问题研究

作业成本法由于在分配间接费用方面的优势而被引入项目成本核算中.通过实证分析,进一步揭示了作业成本法下的项目成本核算在解决医院成本控制、医改财政补偿、医疗服务定价改革中将发挥的积极作用及重大现实意义.     

重庆市基本公共卫生服务标准化流程及其成本测算研究

目的研究重庆市基本公共卫生服务标准流程所需的人力时间成本。方法本研究于2012年根据《国家基本公共卫生服务规范（2011年版）》,制定社区实施公共卫生服务的具体操作流程。采取随机抽样的方法在城市及农村分别选取重庆市2个社区卫生服务中心或乡镇卫生院及1所妇幼保健院,调查重点人群与全人群服务项目的标准化流程服务时间与所需的支持性成本。结果重庆市完成基本公共卫生服务1万名各类重点人群所需医务人员数分别为：健康档案需医务人员3．4名,高血压管理需医务人员10．8名,糖尿病管理需医务人员10．6名,老年人管理需医务人员9．2名,儿童保健需医务人员4．6名,孕产妇保健需医务人员24．3名,精神病患者管理需医务人员13．3名,儿童计划免疫需医务人员4．6名。除重点人群以外,全人群服务项目每10万服务对象需医务人员2．4名。完成基本公共卫生服务1名各类重点人群所需人力时间货币成本分别为：健康档案需22．67元,高血压需72．69元,糖尿病需71．34元,老年人需61．50元,精神病患者需74．25元,儿童计划免疫需30．68元,儿童保健需30．88元,孕产妇产前健康管理及产后访视（包括产妇与婴儿）需人力时间货币成本157．15元。提供每10万人的基本公共卫生服务全人群服务需12．49万元。结论现有医务人员编制数量明显不足,基本公共卫生服务需进一步完善社区人员配置。     

关于医师医学人文精神培育的思考

医学人文精神是医学赖以产生、存在和发展的重要精神支柱。现代社会随着生物医学模式向生物一心理一社会医学模式的转变,要求当代医务人员不仅应具备渊博的医学知识和精湛的医技,更应具有高尚的医学人文精神。为此,必须通过多种途径培育医师的医学人文精神。只有这样,医学的人文本性才能够得到充分的体现。     

New professionalism, medical education and healthcare systems

The scope of this paper is to discuss how so-called "new professionalism" can help in how the education of physicians is conducted, by taking into account the effects of globalization both on the situation of health and on the needs of health professionals with particular emphasis on European Union countries, which are engaged in a profound process of reform in university education. To achieve this, first we present the basic concepts of "new professionalism" and the key strategies of current medical education, which is to train physicians capable of dealing with ethical, scientific and professional challenges that are arising at the beginning of this century. The interdependence of reforms in the undergraduate, graduate and ongoing training areas is then emphasized. The challenges and difficulties to be faced when switching to different stages of medical education are then outlined. It was concluded that, notwithstanding recent reforms in medical education, their great complexity and the still limited availability of contrasting assessments of their results, there are strong synergies between the principles and values of the "new professionalism" and the objectives of the reforms.     

医疗成本控制的理论与实践

医疗费用的控制存在着一个两难困境，医疗费用的上升带来很多社会、政治和经济的问题。其上升的原因主要是医疗服务部门的浪费、欺诈和权利的滥用，人口结构的变化以及管理的效率等。控制成本上升的方法有管理保健方法和总额预算方法。如果引进管理保健政策，可能对中国医疗费用的降低没有多大帮助。可以借鉴总额预算的有关做法来降低医疗服务的成本，这对患者、医疗服务的提供者、医疗卫生的管理者和整个社会而言都有好处。     

Regulating the cost of institutional healthcare through competitive bidding

A system for prospective rate setting based on the theory of auctions is proposed. In order to guarantee that competition will achieve public health goals, the State Health Planning and Development Agency will issue a limited number of patient day certificates. Hospitals can obtain these certificates by offering bids in the form of rate increases. Hospitals offering low rate increases will receive patient day certificates with authorized rate increases equal to their own proposed rate increases plus a bonus. Hospitals offering high rate increases will receive only a base rate increase equal to the smallest rate increase offered by any hospital. This approach enjoys the cost minimizing benefits of competition while restraining hospital capital expenditures.     

Community-based medical education: feasibility and cost

The General Medical Council has issued a call for an increase in community-based medical education, and many medical schools are enhancing the community component of their curricula. This paper uses the experience of a community-based junior medical firm to explore the potential costs, and highlight some of the unresolved problems, which a major transfer of education to the community might engender. Community-based medical education is not a cheap option. The cost of this programme for the academic year 1992–93 was £266494, or £60 per student session. This compares with the Service Increment for Teaching and Research (SIFTR) provision of £41140 per student per annum, or (excluding the 25% of SIFTR which is supposed to cover research costs), £64 per student session. There are a number of possible ways of funding community-based education, including a diversion of SIFTR toward departments of primary health care. As this would have serious implications for the financial viability of some medical schools, an urgent discussion about the future funding of medical education is required.