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为深化公立医院改革,北京同仁医院积极开展门诊知名专家团队服务模式试点工作,建立医院内部层级诊疗服务新模式。通过门诊就诊流程调整、服务模式变革,破解“挂号难”“号贩子”等相关问题,实现了医院内部门诊资源的优化利用,是医院内部分级诊疗的有益实践与探索,真正体现了医疗机构“以患者为中心”的服务理念,也为未来广泛推广分级诊疗模式奠定了坚实的基础。 相似文献
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分级诊疗是国家推动基层和社区医疗发展的全新政策,导师制科教管理模式在分级诊疗中的开展目前尚处于起步阶段,在实际实施过程中还存在着一定的问题和不足。如何使导师制科教管理模式在分级诊疗中发挥更大作用,以导师制促进区域医疗联合体(医联体)管理模式的建立、健全导师考核体系以及建立“学校—三级医院—医联体社区医院”3层教育管理体制是医院转型发展关键时期应该尝试的科教管理方法,也是打破医院传统管理模式、提高医院管理效率的一个有效手段。 相似文献
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文章阐述了居民健康卡医疗机构应用的意义,介绍了居民健康卡医疗机构预约诊疗、门诊住院一卡通、门诊便捷输液、医疗救治联动服务和新农合一卡通等应用,分析了居民健康卡项目建设中政府主导与银医合作两种模式的特点,最后探讨了居民健康卡医疗机构应用重点建设内容。 相似文献
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通过对宁夏县级医院耳鼻咽喉科医疗服务现状的调查,了解其发展瓶颈与不足,提出提升宁夏县级医院耳鼻咽喉科医疗服务能力的建议。方法 采用整群抽样方法,对宁夏县级公立综合医院耳鼻咽喉科进行问卷调查,并抽样访谈部分医院耳鼻咽喉科主任,回收、整理、分析相关数据,定量定性分析调查医院耳鼻咽喉科医疗服务能力。结果 宁夏县级医院耳鼻咽喉科各项现状指标均低于县医院标准要求,科室人员与设备数量严重不足,可开展医疗技术项目少,门诊、出院人数逐年提高。结论 宁夏县级医院耳鼻咽喉科医疗服务能力不足,建议科室制定发展规划,创新发展方式;开发人力资源,提升技术水平;借助信息平台,共建学科联盟。 相似文献
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How health care providers are paid affects how medicine is practiced. It is thus important to assess provider payment models not only from the economic perspective but also from the ethical perspective. China recently started to reform the provider payment model in the health care system from fee‐for‐service to case‐based payment. This paper aims to examine this transition from an ethical perspective. We collected empirical studies on the impact of case‐based payment in the Chinese health care system and applied a systematic ethical matrix that integrates clinical ethics and public health ethics to analyze the empirical findings. We identified eleven prominent ethical issues related to case‐based payment. Some ethical problems of case‐based payment in China are comparable to ethical problems of managed care and diagnosis related groups in high‐income countries. However, in this paper we discuss in greater detail four specific ethical issues in the Chinese context: professionalism, the patient‐physician relationship, access to care and patient autonomy. Based on the analysis, we cautiously infer that case‐based payment is currently more ethically acceptable than fee‐for‐service in the context of China, mainly because it seems to lower financial barriers to access care. Nonetheless, it will be difficult to justify the implementation of case‐based payment if no additional measures are taken to monitor and minimize its existing negative ethical implications. 相似文献
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Marieke van Eijk 《Culture, medicine and psychiatry》2017,41(4):590-608
What is a clinician to do when people needing medical care do not have access to consistent or sufficient health insurance coverage and cannot pay for care privately? Analyzing ethnographically how clinicians at a university-based transgender clinic in the United States responded to this challenge, I examine the U.S. health insurance system, insurance paperwork, and administrative procedures that shape transgender care delivery. To buffer the impact of the system’s failure to provide sufficient health insurance coverage for transgender care, clinicians blended administrative routines with psychological therapy, counseled people’s minds and finances, and leveraged the prestige of their clinic in attempts to create space for gender nonconforming embodiments in gender conservative insurance policies. My analysis demonstrates that in a market-based health insurance system with multiple payers and gender binary insurance rules, health care may be unaffordable, or remain financially challenging, even for transgender people with health insurance. Moreover, insurance carriers’ “reliance” on clinicians’ insurance-related labor is problematic as it exacerbates existing insurance barriers to the accessibility and affordability of transgender care and obscures the workings of a financial payment model that prioritizes economic expediency over gender nonconforming health. 相似文献
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Ami Klin Amy M. Wetherby Juliann Woods Celine Saulnier Jennifer Stapel-Wax Cheryl Klaiman Warren Jones Emily Rubin Lawrence Scahill Nathan Call Karen Bearss Chris Gunter Charles J. Courtemanche Anthony Lemieux James C. Cox David S. Mandell James P. Van Decar Ronald A. Miller Cherri L. Shireman 《The Yale journal of biology and medicine》2015,88(1):73-79
The burdens faced by military families who have a child with autism are unique. The usual challenges of securing diagnostic, treatment, and educational services are compounded by life circumstances that include the anxieties of war, frequent relocation and separation, and a demand structure that emphasizes mission readiness and service. Recently established military autism-specific health care benefits set the stage for community-viable and cost-effective solutions that can achieve better outcomes for children and greater well-being for families. Here we argue for implementation of evidence-based solutions focused on reducing age of diagnosis and improving access to early intervention, as well as establishment of a tiered menu of services, individualized to the child and family, that fit with the military ethos and system of health care. Absence of this new model of care could compromise the utility and sustainability of the autism-specific benefit. 相似文献
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It is now about 15 years since the introduction of the market into health care in China. This produced fundamental changes in the way that health care is financed and resulted in the disappearance of universal free basic health care. Responsibility for provision of health services has been devolved to the provincial and county governments, and healthcare providers have been given considerable financial independence. A fee for service system has been introduced, and several different payment mechanisms are now in operation. The new financing and pricing structures are responsible for greater inequity of access to services and more inefficient use of resources. These problems are widely acknowledged, and a range of solutions is being developed and tested. Since the introduction of the reforms the measurable health status of the population has not declined, probably as a result of overall improved socioeconomic conditions and a continued emphasis on prevention. 相似文献
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总额预付制是由医保部门在对医疗机构进行评估后,计算出人均医疗费用,根据服务量和人均医疗费用,测算出医院的年度费用标准,按此费用标准向医院预付定额的医疗费。对上海医保总额预付制的模式、实施成效、存在的问题进行了思考和探讨,对总额预付的运用及改进提出了初步的设想,以此推动医疗保险付费方式改革的持续进展。 相似文献
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Fleck LM 《Bioethics》1990,4(2):97-120
Fleck divides his paper on health care rationing into three parts. In the first part, he presents and critically assesses the moral problems posed by invisible rationing mechanisms. He claims that such mechanisms, by being localized, privitized, and unofficial, violate Rawls's publicity condition that is an essential part of our concept of justice. In the second part, he analyzes and criticizes the role that prospective payment mechanisms such as health maintenance organizations (HMOs), diagnosis-related groups (DRGs), and Great Britain's National Health Service play as invisible rationing mechanisms. He suggests that if HMOs could be structured so as to satisfy the publicity condition, a national system of HMOs could achieve cost containment objectives. In the third part of his paper, Fleck describes such a system of HMOs in detail, and assesses it from the perspective of justice. 相似文献