GP reimbursement and visiting behaviour in Ireland

In Ireland, approximately 30% of the population receive free GP services (medical card patients) while the remainder (private patients) must pay for each visit. In 1989, the manner in which GPs were reimbursed by the State for their medical card patients was changed from fee-for-service to capitation while private patients continued to pay on a fee-for-service basis. Concerns about supplier-induced demand were in part responsible for this policy change. The purpose of this paper is to examine the extent to which the utilisation of GP services is influenced by the reimbursement system facing GPs, by comparing visiting rates for the two groups before and after this change. Using a difference-in-differences approach on pooled micro-data from 1987, 1995 and 2000, we find that medical card eligibility has a consistently positive and significant effect on the utilisation of GP services. However, the differential in visiting rates between medical card patients and others did not narrow between 1987 and 1995 or 2000, as might have been anticipated if supplier-induced demand played a major role prior to the change in reimbursement system.     

高压氧舱内患者吸氧困难分析与措施

本文分析了在高压氧治疗过程中造成患者吸氧困难原因及解决方法。     

Physician supply, supplier-induced demand and competition: empirical evidence from a single-payer system

We examined the earnings of 8106 office-based (FTE) physicians in 2002 in Taiwan for evidence of supplier-induced demand (SID). We hypothesize that SID, operating in the form of mutual cross-specialty referral, will cause earnings to increase with total physician density (all specialties taken together), but simultaneously, decrease with increasing competition within specialties. We used multiple regression analyses controlling for high-user population, physician demographics and practice type. The evidence supports our hypotheses. Increasing total physician density (all specialties) is positively associated with earnings. Concurrently, within specialties, increased competition is associated with reduced earnings. The medical appropriateness of increasing health care utilization with increasing physician supply cannot be directly determined from the data. However, evidence of a steady earnings increase with increasing total physician density, which precludes a saturation point (of appropriate care levels) at some optimum physician density, substantiates SID in the office-based practice market. Empirically, our data suggest that the average market effect of physicians on one another is synergic when all specialties are considered together, but competitive within each specialty.     

医疗器械证件智能化管理应用的发展趋势

医疗器械证件管理是一个看似简单却极其繁琐的工作.其简单体现在医疗器械证件内容的组成,其繁琐体现在耗材品种多、证件数量大、效期无序、归档复杂、真伪难辨等多方因素.本院较早地采用供应商云平台管理模式,包含多级多点的协同管理方式,嵌入医疗器械的供应链环节中,针对上述繁琐因素进行分解,初有成效,但在应用中仍感不够便捷、人性.本研究希望通过信息化智能化的手段,进一步提高各级用户的体验度.改进方案从虚拟柜、移动终端,电子签章,SaaS云平台用户及功能拓展三方面介绍,最终建立一套标准的便捷的SaaS云平台,达到供方、医院、监管部门互联互通,从医疗器械证件管理开始发散,延伸至各角度需求.这也是本院目前所努力探索的方向.     

流程再造管理在消毒供应中心的应用

目的探索医院消毒供应中心的质量管理方法。方法将现有流程进行再造。采用流程管理,对消毒供应中心的布局流程、集中管理、污染回收、清洁消毒、包装灭菌、物品发送质量流程的执行情况进行监督。结果简化了工作流程,提高了工作效率,降低了管理难度,有效保证了无菌物品质量。结论流程再造管理能提高护理人员服务意识,增强质控管理效能,促进消毒供应中心规范化管理。     

医疗器械供应商合作年限统计与分析

通过对某医院2010年至2013年4月的医疗器械供应商合作年限进行统计,简要分析了不同年限供应商的特点、影响合作年限长短的主动可控因素和被动不可控因素,指出了医院要综合利用电子交易平台、集中配送等多种模式来减少被动影响,同时主管部门应提高供应商准入门槛并加强监管,以减少供应商频繁变更给医院医疗工作带来的不利影响。     

农村改厕现况调查

目的了解农村改厕现况,为政府制定推进农村改厕工作的相关政策、措施提供依据。方法本次调查按照安徽省地域分布选择江淮之间的肥西县、江南的当涂县、淮北的临泉县作为调查县,每县选择农村卫生厕所普及率高、中、低3个村作为调查村,定性调查相关企业2家和政府等改厕管理人员19人。结果 345名调查对象中338户有厕所,7户无厕。338户厕所中,卫生厕所占54.4%。96.7%的改厕户对现有的厕所持满意态度,65.2%的调查对象迫切需要改厕,定性调查表明,改厕引入市场化有一些困难。结论农村改厕应坚持政府主导,部门配合的机制,同时要努力提高农村居民的自主改厕意识。     

汽油加油站加油人员免疫功能的研究

目的 研究汽油对人体免疫功能的影响。方法 使用血球计数仪检测汽油加油人员组及对照组白细胞总数和分类，使用生化分析仪检测该两组的免疫球蛋白及补体C3、C4的数据。结果 汽油加油人员组的T淋巴细胞（％）、IgG均比对照组低，而补体C3增高，且随接触汽油时间延长这种差异愈明显。结论 吸入汽油使人体免疫功能有下降趋势，且随接触汽油时间延长，这种趋势愈明显。     

廊坊市加油站作业工人健康状况调查

目的了解廊坊市加油站作业工人的健康状况及长期接触汽油及苯作业对加油工人健康的影响。方法对廊坊市273名加油站作业人员进行职业健康检查,检查项目包括:内科常规、神经科、血常规、尿常规、血清丙氨酸氨基转移酶、心电图及腹部B超等,并对体检结果进行分析。结果加油工人神经衰弱综合征检出率为7.0%,高血压检出率22.3%,血常规异常检出率12.5%,尿常规异常检出率21.6%,心电图异常检出率11.4%,腹部B超异常检出率19.4%,肝功异常检出率7.3%。趋势卡方检验表明,加油工高血压、血常规异常、尿常规异常、腹部B超异常、心电图异常检出率均有随年龄增长而增高的线性趋势(P0.05);高血压、血常规异常、尿常规异常、心电图异常检出率均有随工龄增长而增高的线性趋势(P0.05)。结论廊坊市加油站作业工人长期接触汽油及苯,对其神经系统、造血系统、泌尿系统、心血管系统等都造成一定程度的慢性损害。     

当前医用气体建设中的若干问题与建议

本文列举了当前医用气体建设中存在的部分问题,并结合医院动力工程设计,提出了相关建议.