江苏省儿童专科夜间门诊诊察费定价政策成效分析

2019年5月20日,江苏省医保局推出调整了儿童专科夜间门诊诊察费收费标准举措。文章以江苏省某三甲综合医院为样本,围绕上述政策实施后儿科诊疗工作量、病人满意度、医院收入影响等方面进行了调查,结果表明,上述政策可满足儿科病人就诊差异化需求,合理分流病人,保障急诊优先的诊疗秩序。     

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.     

A Financial Plot to Reduce the Burden of Medical School Tuition Fees

Tuition fees for medical school are continuously and riotously increasing. This upsurge is amassing debts on the backs of students. In the class of 2018, 75% finished medical school with an outstanding balance of $196,520, on average—a $5826 increase from 2017. Tuition fees differ in terms of the ownership of the medical school (public vs. private) and according to the medical student residence status (in-state or out-of-state). It is critical that students arrange a long-term budget that shows them where they stand: in surplus or in deficit. Students may classify expenditures into two groups: “fixed” and “variable,” where they can manipulate the variable expenses to fit into their budget. To pay for their tuition, medical students have four possibilities: cash, scholarships and grants, service-obligation scholarships, and loans. Loans are the most common alternatives, and so there are Traditional Repayment Plans and Income-Driven Repayment Plans. This article serves to provide medical students with attainable alternatives for funding their education and for repaying their debts.     

Out‐of‐pocket costs for paediatric admissions in district hospitals in Kenya

Objective To describe out‐of‐pocket costs of inpatient care for children under 5 years of age in district hospitals in Kenya. Methods A total of 256 caretakers of admitted children were interviewed in 2‐week surveys conducted in eight hospitals in four provinces in Kenya. Caretakers were asked to report care seeking behaviour and expenditure related to accessing inpatient care. Family socio‐economic status was assessed through reported expenditure in the previous month. Results Seventy eight percent of caretakers were required to pay user charges to access inpatient care for children. User charges (mean, US$ 8.1; 95% CI, 6.4–9.7) were 59% of total out‐of‐pocket costs, while transport costs (mean, US$ 4.9; 95% CI, 3.9–6.0) and medicine costs (mean, US$ 0.7; 95% CI, 0.5–1.0) were 36% and 5%, respectively. The mean total out‐of‐pocket cost per paediatric admission was US$ 14.1 (95% CI, 11.9–16.2). Out‐of‐pocket expenditures on health were catastrophic for 25.4% (95% CI, 18.4–33.3) of caretakers interviewed. Out‐of‐pocket expenditures were regressive, with a greater burden being experienced by households with lower socio‐economic status. Conclusion Despite a policy of user fee exemption for children under 5 years of age in Kenya, our findings show that high unofficial user fees are still charged in district hospitals. Financing mechanisms that will offer financial risk protection to children seeking care need to be developed to remove barriers to child survival.     

Secrets on both sides of the couch

This paper considers omissions and lies in the consulting room, discussing what is known about the nature, extent, and underlying causes of therapists’ deceptions and secrets. The author offers clinical vignettes to illustrate common omissions and deceptions, considers potential ramifications thereof, and concludes with recommendations for clinical practice.     

临床护理路径在精神分裂症临床护理中的应用效果评价

目的：探讨临床护理路径在精神分裂症临床护理中的应用效果。方法将92例住院精神分裂症患者随机分为两组。研究组42例,对照组40例。两组均接受精神科常规治疗,对照组应用常规整体护理,研究组应用临床护理路径开展临床护理。观察住院全程。于患者出院时,统计两组的住院时间、医疗费用,采用自制问卷调查患者满意度和健康知识掌握情况,并进行对比分析。结果研究组医疗费用、住院时间显著低于对照组（P＜0．01）,健康教育知识评分、满意率显著高于对照组（P＜0．01）。结论对精神分裂症患者实施临床护理路径,可以缩短患者住院时间,减少医疗费用,提高健康教育效率及患者满意度。     

住院患者欠费问题分析与控制措施

目的:通过住院患者欠费问题的调查,了解欠费发生的方式、特征和时间变化趋势,探讨控制患者欠费的措施。方法:以某军队医院2000-2006年欠费患者资料为本,建立数据库,利用Excel软件对患者身份、住院科室、住院时间和欠费原因等进行统计处理。结果:欠费多发生于外科患者、外地患者和全费患者。欠费方式主要以未结算出院和延期支付为主,且欠费现象有逐年上升的趋势。结论:建立健全预缴金支出的监测系统,强化科室监管制度,管理好特殊人群,以减少欠费现象的发生。     

2424例伤害住院病例分析

目的了解伤害住院病例的构成及其住院费用的分布情况,探讨伤害的预防控制措施和减少伤害的经济损失的途径。方法整群抽取某综合性医院2006年1月1日至2006年12月31日有完整病案记录,并据《ICD-10损伤与中毒外部原因分类》诊断明确的伤害住院病例2424例为研究对象。结果2424例伤害病例中男1781例(73.5%),女643例(26.5%),男女性别比2.78∶1。伤害类型居前三位的分别是交通事故931例(38.4%),其次是钝器伤478例(19.7%)和烧烫伤288例(11.9%)。不同性别、年龄、民族及不同伤害意图的伤害类型构成差异均有统计学意义,P<0.01。伤害意图分析中,意外伤害2186例(90.2%),自杀/自残64例(2.6%),暴力加害174例(7.2%)。自杀/自残以中毒者居多82.8%(53/64),暴力加害以钝器伤62.6%(109/174)和刀/锐器伤33.9%(59/174)者居多。各伤害类型的住院费用比较差异有统计学意义,交通事故所造成的住院费用比重最大。同一年龄组各伤害类型的次住院费用不同;交通事故、跌倒/坠落、钝器伤、烧烫伤、中毒和医疗并发症几种伤害类型,每种类型的年龄组间次住院费用比较差异有统计学意义。结论伤害给患者家庭和社会造成巨大经济负担,应及早针对不同群体频发的伤害类型加以重点防治。     

The equity impacts of community financing activities in three African countries

Although the Bamako Initiative from its very beginning was caught up in wider debates about the potential equity impact of any form of user financing, to date there has been little empirical investigation of this impact. This three-country study, undertaken in Benin, Kenya and Zambia in 1994/95, was initiated to add to the body of relevant evidence. It sought to understand not only what had been the equity impacts of community financing activities in these countries but also how they had been brought about. As a result, it investigated equity primarily through consideration of the design of these financing activities and through the perceptions of different actors, within a limited number of purposively selected geographical areas in each country, about their strengths and weaknesses. Additional data on utilization were either collected during the course of the study (Kenya) or drawn from other available studies (Benin and Zambia). Key issues considered in the studies' assessment of equity were the extent to which both relative and absolute affordability gains were achieved, as well as as an influence over both the distributional and procedural justice of the financing activities, the pattern of decision-making. Across countries there was evidence of relative affordability gains in Benin and Kenya, but Kenyan gains were not sustained over time and no such gains were identified in Zambia. In addition, no country had given attention either to the issue of absolute affordability, through the implementation of effective exemption mechanisms to protect the poorest from the burden of payment, or to the establishment of community decision-making bodies that effectively represented the interests of all groups including the poorest. Overall, therefore, although the Benin Bamako Initiative programme might be judged as successful in terms of what appear to be its own equity objectives, the other two countries' schemes had clear equity problems even in these terms. The experience across countries also highlights the unresolved question of whether equity is concerned with the greatest good for the greatest number or with promoting the interests of the most disadvantaged.     

Association between volume and charges for most frequently performed ambulatory and nonambulatory surgery for bladder cancer. Is more cheaper?

PURPOSE: We investigated the relationship between provider volume and charges for transurethral bladder tumor resection (TURBT) and radical cystectomy in patients with bladder cancer. MATERIALS AND METHODS: The National Inpatient Sample (1988 to 1999) of the Health Care Utilization Project, and State Ambulatory Surgery Databases for Wisconsin and Florida (2000 data set) were used for analysis. All patients with bladder cancer who had undergone radical cystectomy or TURBT as the principal procedure were identified. Hospitals and surgeons were categorized into terciles of volume based on the average number performed per year. The average hospital charge per discharge/procedure corrected to 2000 levels was calculated. One-way ANOVA with the Bonferroni correction was used to compare charges between different volume levels. RESULTS: A total of 13,498 patients who underwent radical cystectomy and 5,954 who underwent TURBT were included in the analysis. Charges for radical cystectomy were 5,648 USD lower at high volume hospitals than at low volume hospitals (p <0.001). High volume surgeons were 2,976 USD less expensive than low volume surgeons (p =0.054). For TURBT total hospital charges at high volume hospitals were 1,013 USD more than at low volume hospitals (p <0.0001), while average total hospital charges for procedures performed by high volume surgeons were 919 USD less compared to low volume surgeons (p <0.0001). CONCLUSIONS: High risk inpatient procedures for bladder cancer such as cystectomy, which are more influenced by systems of care, are less expensive to perform at high volume centers. Lower risk ambulatory procedures for bladder cancer, such as TURBT, which are not influenced by systems of care, may be more cost efficiently performed by high volume surgeons at low volume centers.