经济社会新常态下的过度医疗再探讨

过度医疗作为新医改进程中亟待解决的社会热点和难点问题,是导致“看病贵、看病难”、“恶性医疗事件频发”的重要原因。本文重新探讨经济社会新常态下过度医疗的现状、表现形式和新特点,提出防治过度医疗的措施建议,以期从根本上解决“看病贵、看病难”问题,推进健康中国建设。     

信息不对称下公立医院过度医疗的治理

过度医疗作为医疗实践中的不良现象,是引发医疗纠纷和“看病贵”的重要原因。文章从信息不对称的角度,通过分析我国公立医院过度医疗治理现状,找出当前我国公立医院过度医疗治理存在的问题,提出信息不对称下公立医院过度医疗的治理模式,以期从根本上遏制公立医院过度医疗问题的发生。     

我国公立医院过度医疗网络治理研究

在当前经济社会新常态下,过度医疗问题依然存在,其治理问题形势严峻。本研究从医、患、督、社会第三方不同视角切入,运用网络治理理论,分析研究各治理主体之间关系构成,构建过度医疗网络治理模式。     

公立医院过度医疗根源及对策浅析

“小病大治,大病豪治”的过度医疗现象屡见不鲜,不仅没有提高医疗效果,反而给患者及其家庭带来了沉重的负担。针对过度医疗一直是公立医院难以解决的顽疾,尝试探讨过度医疗产生的根源,并提出相应的解决办法。     

基于多层感知器网络的过度医疗防治绩效评价研究

目的 通过多层感知器网络的构建评价过度医疗防治的效果,为进一步完善过度医疗防治体系提供参考。方法 基于多层感知器网络,构建了具有三层神经网络、9个隐含层节点数的过度医疗绩效评价模型。结果 多层感知器网络的训练结果与专家评价（期望结果）两者评价是完全一致的。 结论 该多层神经网络及其评价指标的选取能够很好的应用于医疗服务中的过度医疗防治绩效评价。     

医疗美容医疗纠纷成因分析及对策探讨

医疗美容科是外科手术较为频繁、患者对手术期望极高的科室。患者所要求的不仅仅是安全,而且对术后效果更为重视,整形美容科术后效果不佳是整形美容科医疗纠纷高发的重要原因之一。通过对整形美容医疗纠纷成因进行分析,消除医疗事故隐患,规避医疗风险。     

三级甲等公立医院过度医疗形成影响因素研究

目的 分析医方以及患方对过度医疗形成的影响因素,探讨过度医疗的形成机理。方法 随机抽调某省5所三级甲等医院进行问卷调查。运用结构方程模型,通过软件SPSS19.0和AMOS17.0进行数据分析处理。结果 医患之间的信息不对称以及医务人员自身薪酬待遇不足等因素对过度医疗的形成产生重要影响。结论 提高医务人员的薪酬待遇和消除医患之间的信息不对称是解决过度医疗问题的关键。     

论过度医疗侵权行为与患者知情同意侵权行为的竞合

过度医疗与患者知情同意侵权是《中华人民共和国侵权责任法》规定的两种独立的医疗侵权行为。过度医疗是一种由于医师在对患者疾病治疗过程中,实施了明显超过疾病治疗实际所需的诊疗措施,而导致患者合法权益严重受损的医疗侵权行为。患者知情同意侵权行为则泛指医师在医疗过程中,由于实施了违法告知说明义务而导致患者合法权益损害的医疗侵权行为。过度医疗中由于医师履行告知义务的违法性与患者知情同意侵权行为产生竞合。这一结论不仅有利于《中华人民共和国侵权责任法》第六十三条的法律适用,同时也为患者提供了另一法律救济途径。     

新医疗改革背景下医院医疗行为改变的探讨

目前世界上各国政府均面临着卫生费用不断增长和医疗卫生服务需求日益增加的局面,无论是美国的市场主导型医疗保险市场,还是西欧国家实施的政府主导福利型医疗保险市场,都没有解决这个问题.在现有医保政策的引导下,一些公立医院也开始调整内部制度,引导医务人员行医行为契合医保政策要求.本论文通过研究某三级甲等医院内部控制费用政策的实施效果,为进一步促进医疗保险政策引导医疗市场各方行为提供了有建设性意义的意见.     

Development of an Intelligent Mobile Health Monitoring System for the Health Surveillance System in Indonesia

Mobile phone applications have been widely used in various fields, including health care. Generally, this technology is used to overcome problems in health care by utilising mobile phone features for facilitating basic needs in health services. This study proposes an intelligent mobile health monitoring system that can be used in rural and remote areas where health services are still lacking. The system was made based on client/server architecture. Nine symptoms of typhoid, cough and diarrhoea from 30 patients were gathered from a hospital. Based on this data, a machine learning model using Support Vector Machine (SVM) was performed to distinguish these diseases. To find the best model parameters of the SVM, three different kernels (linear, polynomial, and Radial Basis Function (RBF)) were analysed. The result showed that RBF with degree 2 provided the best result in this particular application. The system was designed to receive input from patients about symptoms of the disease they have. The mobile phone application sends the data of the symptoms using Short Message Service (SMS) to the server. Furthermore, a machine algorithm module in the server identifies to which disease it belongs to based on the machine learning model created before. The prediction result is accessible to the doctor and the nearest Community Health Center (CHC). Based on the result, the doctor proposes a treatment plan for the patient to be recorded and sent to the patient by CHC. The proposed mobile health monitoring system has run properly and is ready to be evaluated in a real situation.     

我国现行医疗卫生政策的相关问题分析

医疗卫生是构建和谐社会的重要因素之一,也是关乎百姓切身利益的重大问题之一,近年来,医疗体制的不断改革,医疗卫生的相关政策的不断出台,已经大大地改善了我国广大人民群众的“看病难,看病贵”等问题,增加了医保的覆盖人群,减轻了城市低收入人群及农村的医疗负担,但是,我们仍面临着巨大的挑战,新的问题也不断涌现,医疗卫生政策不适应现在的医疗需求发展、经济发展不均衡、不同层次群众的医疗需求有差异等,都是医疗卫生改革中面临的问题,医疗改革的不断推进势在必行。我国的医疗保障制度覆盖率已经达到95％,但是,现行的医疗保障制度的还不能从根本上解决人民群众的“就医难,治病贵”的问题,其他医疗保险不能与现行的医疗保障制度相适应,从而,影响了我国整体的医疗水平的提高。     

一类有投放率系统的控制策略

使用微分方程理论研究了有投放率时一类云杉蚜虫与其天敌模型在相互作用过程中所呈现的动态性质,通过对反馈增益值的选取,得到了系统达到稳定平衡状态的条件,同时保证了实际中蚜虫的密度相对小．     

The Quality of Mental Health Care for African Americans

In response to the Surgeon General's request for more research on racial disparities in mental health care, especially research that includes high-need populations (e.g., the homeless, incarcerated, children in foster care, and substance abusers), we examined racial disparities in the provision of mental health counseling, psychotherapy, and pharmacotherapy in hospital outpatient settings using nationally representative data from the 1997 National Hospital Ambulatory Medical Care Survey (NHAMCS). After controlling for diagnosis and other factors, we found that African Americans were less likely than whites to receive mental health counseling and psychotherapy, but more likely than whites to receive pharmacotherapy. We also found that substance abuse clinics were more likely than primary care and specialty mental health clinics to provide mental health counseling and psychotherapy. However, specialty mental health clinics were the only clinics to provide pharmacotherapy. Future research should examine racial disparities in a variety of settings, controlling for diagnosis as well as other factors.     

Indigenous Medicine and Primary Health Care: The Importance of Lay Knowledge and Use of Medicinal Plants in Rural South Africa

Indigenous medicine is important to rural livelihoods, but lay knowledge and use of medicinal plants has not been extensively studied. Research in KwaZulu-Natal, South Africa, showed that medicinal plants were frequently used by villagers and contributed to their ability to cope with health problems. Knowledge of plants and household remedies was extensive and varied in that households often held different knowledge. Villagers mainly relied on common species, and were generally aware of alternative species for a certain ailment. People were flexible in their use of indigenous and western health care, which were both perceived as beneficial. Improved cooperation between health care systems could improve health standards. Extraction of medicinal plants has been described as unsustainable in the region—a situation not found in the study area. It is argued that conservation policies aimed to restrict access should be differential and potentially not include local consumption, since this may be ecologically unnecessary and entail local hardships.     

蜜源花粉的保健、美容与药膳

对花粉的利用历史,营养成分、药理作用等进行了论述,并收集了部分花粉美容、保健药膳等部分配方.     

The Framing of Teenage Health Care: Organizations,Culture, and Control

Adolescent health is one of the most polemical healthissues that has swept the United States in recentyears. This study is about documenting the process ofa project on teenage sex, drug, and alcohol abuse ina small rural California town. It illustrates adynamic set of concerns that impinge on health issues:development and underdevelopment, experts and laypeople, young and old, in a context of thetransformation of a rural economy to a prison-basedindustry. It is also about covert forms of control,pacification, burnout, and teenagers caught in thecrossfire between bureaucratic institutions andcontradictory messages about adolescent health as theycorrespond to changing conditions betweeninstitutional power holders.     

神木“全民免费医疗”的可推广性探讨

神木模式是我国＂全民免费医疗＂的一次创造性探索,虽然它不是真正意义上的全民免费医疗制度,但对比目前新医改推广的＂全民医保＂制度而言,它在解决群众＂看病难、看病贵＂的问题上起到更积极的作用,对全国也起着一定的借鉴意义。     

Future direct and indirect costs of obesity and the influence of gaining weight: Results from the MONICA/KORA cohort studies, 1995-2005

Over the last two decades, the prevalence of obesity has risen worldwide. As obesity is a confirmed risk factor for a number of diseases, its increasing prevalence nurtures the supposition that obesity may present a growing and significant economic burden to society.The objective of this study is to analyse the correlation between body mass index (BMI) and future direct and indirect costs, as well as the correlation between changing BMI and future in(direct) costs. Health care utilisation and productivity losses were based on data from 2581 participants aged 25-65 years (1994/95) from two cross-sectional, population-representative health surveys (MONICA/KORA-survey-S3 1994/95 and follow-up KORA-survey-F3 2004/05) in Augsburg, Germany.The predicted average adjusted total direct costs per year and per user were estimated to be €1029-(healthy weight), €1093-(overweight) and €1040-(obesity). There are significantly greater future costs in the utilisation of general practitioners per user and per year at higher obesity levels (€72; €75; €96).The average total direct costs per person for those who stay in the same BMI class are €982, €1000 and €973. An overweight participant who becomes obese incurs significant costs of internists of €160 compared with those who remain overweight (€124). An overweight user incurs indirect costs of €2474, compared with €2136 for those who remain a healthy weight.There is a trend for higher predicted (in)direct costs when people are overweight or obese compared with healthy weight persons 10 years earlier. Potential cost savings could be attained if preventive programs effectively targeted these individuals.     

The Ethical Self-Fashioning of Physicians and Health Care Systems in Culturally Appropriate Health Care

Diverse advocacy groups have pushed for the recognition of cultural differences in health care as a means to redress inequalities in the U.S., elaborating a form of biocitizenship that draws on evidence of racial and ethnic health disparities to make claims on both the state and health care providers. These efforts led to federal regulations developed by the U.S. Office of Minority Health requiring health care organizations to provide Culturally and Linguistically Appropriate Services. Based on ethnographic research at workshops and conferences, in-depth interviews with cultural competence trainers, and an analysis of postings to a moderated listserv with 2,000 members, we explore cultural competence trainings as a new type of social technology in which health care providers and institutions are urged to engage in ethical self-fashioning to eliminate prejudice and embody the values of cultural relativism. Health care providers are called on to re-orient their practice (such as habits of gaze, touch, and decision-making) and to act on their own subjectivities to develop an orientation toward Others that is “culturally competent.” We explore the diverse methods that cultural competence trainings use to foster a health care provider’s ability to be self-reflexive, including face-to-face workshops and classes and self-guided on-line modules. We argue that the hybrid formation of culturally appropriate health care is becoming detached from its social justice origins as it becomes rationalized by and more firmly embedded in the operations of the health care marketplace.