关于开展日间手术的实践和探讨

目的：探索开展日间手术的临床应用价值。方法：通过回顾分析上海交通大学医学院附属新华医院两年多来开展日间手术实践,选择白内障＂超声乳化＋晶体植入＂术、无痛人流术、输尿管镜下碎石术、乳房肿块切除术、声带息肉摘除术、内痔解剖剥脱术等病种与非日间手术进行人均住院天数、人均住院费用、床位周转率等方面比较。结果：日间手术患者平均住院天数明显缩短,人均住院费用明显下降,床位周转率明显提高。结论：开展日间手术可明显缩短人均住院天数、减少人均住院费用、增加床位周转率,是解决当前＂看病难、看病贵＂的一条非常有效的途径。     

269例10万元以上住院费用及影响因素分析

目的分析高额住院费用的成因及影响因素,以控制医疗费用的过快增长.方法选择某综合医院2002年住院费用在10万元以上的病例共269例,分析其费用构成,并对其影响因素进行多元回归分析.结果269例病人的平均费用为159 765元,以治疗费最高,所占比例为51.32%,药费其次,所占比例为36.25%.住院费用的影响因素为:住院天数、院内感染和预后.结论降低过高的住院费用要缩短无效住院日、控制院内感染以及减少无效的治疗和用药.     

住院构成前10位病种的医疗费用分布研究

该文以某三级甲等医院1997年住院构成前10住病种的病例为样本，采用探索性数据分析方法，对出院病例医疗费用的分布进行分析。结果表明，病种医疗费用范围很大，变异程度很高，奇异值较多，概率分布呈正偏态、尖峭峰分布。医疗保险中医疗费用支付定额应根据医疗费用发生的分布情况，选择具有良好代表性的统计量作为标准。     

Patient and parent preferences for orthodontic practices

This study was designed to identify who chooses an orthodontic office and what factors might induce the attraction. Patients and parents from the lists provided by suburban orthodontic offices were contacted. A mail-out survey instrument was used to gather the data. Results revealed that the reputation of the practitioner was most important along with the level of caring attitude the office projected. It was also important that the office is located near home. Interestingly, the mother is the most significant decision-maker in the family in choosing an orthodontic office. Moreover, not the cost of treatment but the payment plan was the critical element in the decision process. The higher income families with three or less children were attracted to office characteristics such as excellence of the orthodontist, attention, and convenience. A marketing strategy based on these elements might provide the best return on the investment.     

实施"一日清单制"的效果评价

我院于2005年7月开始实施医疗费用一日清单制,运行大半年来,取得较好的社会效益和经济效益,不仅维护病人的权益,而且降低了医疗纠纷的发生,现将方法介绍如下.     

Street‐level workers’ criteria for identifying indigents to be exempted from user fees in Burkina Faso

Objectives Universal healthcare coverage cannot be achieved in Africa as long as the indigent, the poorest, are unable to access healthcare systems. This study was carried out in Burkina Faso to obtain street‐level workers’ perspectives on what criteria should be used to select indigents to be exempted from user fees. Methods Two group consensus techniques were used (Delphi and Concept Mapping). The participants were nurses (CM; n = 24), midwives (CM; n = 23) from a rural district and Social Action agents (CM; n = 31) and healthcare workers (Delphi n = 23) in training at two national schools. Results Altogether, 446 criteria were proposed. The nurses put forward criteria related to being ill without support and being a victim of society. The midwives focused more on the disabled poor and those who were ill and unsupported. The healthcare workers in training mentioned disabled persons and the elderly with no family support. The Social Action agents spoke about vulnerability related to illness or disability and the fact of being excluded or being a disaster victim. Conclusions These criteria proposed by street‐level workers add to other studies conducted in Burkina Faso and should help the State to improve indigents’ access to care.