我国分级医疗服务体系建设的关键问题

我国医疗服务体系存在卫生资源布局和利用不合理、缺乏分工协作、基层医疗服务能力薄弱等问题,分级医疗是优化与重构医疗卫生服务体系的有效途径。通过梳理分级医疗的基本内涵、关键问题及其困境,结合我国国情特点和社会分工理论,从系统层面（宏观）、组织层面（中观）、个体层面（微观）以及保障层面对我国分级医疗服务体系建设提出相应路径选择。     

国外老年医疗质量评价研究及其对我国的借鉴意义

随着人口老龄化的发展,老年人医疗服务越来越受到重视。对国外老年医疗质量评价研究进行了系统介绍,并提出应尽快在我国建立适合我国医疗卫生体制的老年人医疗质量评价体系和持续质量改进策略,以满足我国老年人口不断增长的医疗服务需求。     

基于社会分工理论的分级诊疗服务体系研究

医疗卫生服务体系结构复杂，建立规划合理、分工明确的分级诊疗服务体系是保障医疗资源合理配置、提高医疗服务协调性和连续性的重要手段。通过探讨当前分级诊疗服务体系存在的问题，进而结合社会分工理论为形成适应我国国情的分级诊疗制度提出对策建议。     

医疗不良事件报告体系评述

医疗不良事件报告体系对于促进患者安全、提高医疗质量具有重要作用,但各国的报告体系模式有所不同。借鉴国外报告体系的成功经验,为建立和完善适合我国国情的医疗不良事件报告体系提供理论依据。     

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.     

建立适合中国国情的高效双向转诊机制

建立适应我国国情的高效双向转诊机制,对于推进我国的医疗体制改革具有至关重要的作用。本文通过对中西方现行卫生制度的对比,结合我国有中国特色的社会主义国家的国情,对我国的卫生制度中存在的问题进行了深入剖析,探讨如何才能有效地实现高效的双向转诊。目前,我国医疗卫生事业的问题覆盖多个方面：主要表现在医疗资源,医院管理,在岗医护人员的个人职业素质,卫生部门的监管,医疗资源的大量浪费,医院分级不平衡另多数患者普遍选择三级医院就诊,而选择二级以下医院就诊的患者则较少。如何在符合我国国情的基础上改变我国的医疗卫生现状、满足人民群众不断提高的医疗服务需求是我国医疗改革亟待解决的问题。建立高效率的双向转诊制度势在必行。目前,在双向转诊中遇到的问题：1．传统理念导致的对各级医疗机构职能的理解上存在偏差,2．医疗机构自身定位不明确,3．双向转诊制度的各项相关配套政策不完善,4．双向转诊制度的社会认同度低。高效双向转诊机制建立以后,可以节省大量的医疗资源,减少了不必要的浪费,推进了医疗资源的合理配置,减少了因地区差异引起的治疗时机延误,高效的双向转诊制度会使医疗卫生资源配置进一步优化、还可以加强医疗机构之间的协作、降低医疗费用支出、促进社区卫生服务迅速发展等有重大的意义。     

基于模糊综合评判法的医院费用规制效果综合评价

??????? 目的 评价我国医疗费用规制策略效果,筛选优先干预策略。方法 运用模糊综合评判法对医院费用的重要规制手段：医疗服务定价方式、药品流通体制、医疗保险支付方式的重要性、可操作性、失效程度、干预迫切性四个维度进行综合评价。 结果 导致我国医疗费用控制效果不佳的首要原因在于药品流通体制的管制失效;现行医保支付方式对医疗费用的规制作用不强,这是导致快速上涨的医疗费用难以得到有效遏制控制的第二位原因。 结论 改善我国医疗费用规制效果的优先策略是进一步强化药品流通体制规制改革的推进力度;其次,亟待深化医保制度支付方式的费用控制机制探索,发挥医保制度作为第三方对医疗费用的重要规制作用。     

浅析医疗投诉管理的必要性及其原则

在医疗卫生服务事业蓬勃发展的同时,医患关系也日趋紧张。对医疗投诉的原因、规范医疗投诉管理的必要性、正确看待医疗投诉等问题进行了阐述,为提高医疗服务质量、规范医疗服务流程提供参考。     

和谐医患关系目标下的医疗损害补偿制度研究

目前,我国主要适用《中华人民共和国侵权责任法》处理医疗损害,对因医务人员过失导致的医疗损害进行赔偿,这一模式为解决医患纠纷作出了巨大贡献,但其中也存在着当事医师赔偿比例不清、对因无过错医疗行为导致的医疗损害救济不够、赔偿周期漫长等问题。主要针对目前医疗损害赔偿模式的困境与问题,构建适合我国国情的医疗损害补偿制度,并对医疗损害补偿制度中的资金来源与使用、赔偿标准等关键问题进行探讨。

     

影响新医疗技术使用的决定因素分析

近年来,新医疗技术的引进和使用被认为是医疗费用持续增加的主要原因之一。过去国内外有关控制医疗费用政策的研究,多数探讨引进新医疗技术的影响因素与医疗费用之间的关系,很少从医生使用新医疗技术影响因素的角度来分析。通过文献综述的方式,讨论影响新医疗技术使用的决定因素,借此帮助政府及卫生部门设计控制医疗费用的策略。

     

军队医院医疗风险管理的措施及意义

随着我国法治社会的发展及医疗体制的改革,医疗风险成为军队医院管理面临的难题和挑战。目前,我国现有的医疗法规不够完善,医务人员与患者的医疗风险防范意识不足,社会舆论导向性偏移等问题制约着我国医疗系统的发展。作为医疗卫生系事业的重要力量,军队医院要加强医疗风险管理,制定风险评估方法,完善风险管理体系以及加强风险教育,进一步提高医疗服务质量,从而有利维护军队医院在群众心中的信誉和形象。     

The problematization of medical tourism: a critique of neoliberalism

The past two decades have seen the extensive privatisation and marketisation of health care in an ever reaching number of developing countries. Within this milieu, medical tourism is being promoted as a rational economic development strategy for some developing nations, and a makeshift solution to the escalating waiting lists and exorbitant costs of health care in developed nations. This paper explores the need to problematize medical tourism in order to move beyond one dimensional neoliberal discourses that have, to date, dominated the arena. In this problematization, the paper discusses a range of understandings and uses of the term 'medical tourism' and situates it within the context of the neoliberal economic development of health care internationally. Drawing on theory from critical medical anthropology and health and human rights perspectives, the paper critically analyzes the assumed independence between the medical tourism industry and local populations facing critical health issues, where social, cultural and economic inequities are widening in terms of access, cost and quality of health care. Finally, medical tourism is examined in the local context of India, critiquing the increasingly indistinct roles played by government and private sectors, whilst linking these shifts to global market forces.     

Socio-Economics of Medical Care, Report of Bureau of Research and Planning

Interest in the area of medical socio-economics has largely come about due to the proliferation of social welfare programs and advances in the distribution of health services in the private sector of the economy. The increasing role of our government has also been a stimulus. With the advent of new techniques for the financing of care, a large volume of institutional literature has appeared delving into issues which range from the role of the medical profession in the evaluation of quality of medical care to the measurement of demand for and prepayment of numerous types of health care services. Since the area of medical socio-economics is not considered "pure" enough to be categorized as a discipline, the range of periodicals, government and non-government publications and books, in which data are found, is vast. This report will briefly describe some of the more important sources of data in the area of medical socio-economics. Major emphasis is given to the literature which provides current statistical data on the operational aspects of public and private programs providing health care services, and ancillary activities which affect the market for health care activities. Leading publications of governmental and other community agencies are cited to illustrate the range of materials available to the public and to the medical profession.     

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。     

Wall Street's growing influence on plastic surgery

The advent of managed care has unleashed market forces on the health care system. One result of these new pressures is a shift from nonprofit to Wall Street-based financing. This report quantifies these trends by comparing health organizations' financial structures in the 1980s and now. The reasons behind this shift and the function of the stock market are examined. A review of Wall Street's key financial measures confirms that health care has shifted to the stock market as its principal means of financing. The stock market works by assigning a current price to a company's stock based on estimates for future earnings. Thus, companies desire predictability in their costs, revenues, and profits. Plastic surgeons can master this system by meeting the challenges imposed by Wall Street financing. Important steps include continuously measuring costs and outcomes of procedures, demanding cost data from hospitals and payers, using these data to improve costs and outcomes, and taking advantage of the system's openness to innovation and easier access to capital. As they seek to protect their role as medical decision makers under the new free-market system, plastic surgeons can benefit from understanding the mechanisms of the stock market.     

当前医院管理中几个热点问题的辨识

随着市场经济的发展和医药卫生体制改革的不断深入,医院发展面临着新的挑战。围绕医院的社会责任与自身利益、高新技术与基础质量、过度扩张与适度规模、"以病为本"与"以人为本"以及服务意识与服务艺术五个热点问题进行了辩证的思考,力求正确认识现代医院发展过程中存在的诸多问题,寻求有效的解决途径,以促进公立医院可持续发展。     

公立医院品牌保护的探索与实践

随着医疗体制改革的深入,在市场竞争规律调控下,医院品牌影响力成为医院发展的重要因素。因此,实施品牌战略,是现代医疗市场竞争对医院长远健康发展的必然要求。本文通过对阜外心血管病医院“三位一体”品牌保护体系的分析阐述,并借助典型案例进行深入探讨,旨在为公立医院的品牌管理提供一些思路和借鉴。     

Medical simulation: the new tool for training and skill assessment

Medical simulation is a new method to facilitate skill training and assessment. Simulation has achieved a high degree of sophistication in aviation and other fields. However, the complexity of health care, the numerous stakeholders, and the lack of central control of medical education have been barriers to the development and broad implementation of medical simulation. Acceptance by the medical community is growing, with the publication of scientific validation studies, the development of economic models and funding, and the integration of simulation into existing curricula and training programs. The major forces for implementing simulation will most likely come from the medical device industry and from institutions with mandates to improve the quality of health care and enhance patient safety. Certification boards are expected to increase their utilization of simulation technology to objectively assess proficiency of skills relevant to physicians and the health care system. Medical simulation has made the transition from an experimental technology to the clinical world, and the next five to 10 years may be viewed as the golden age of medical simulation.     

ROCCIPI框架下互联网医疗发展的问题识别与分析

互联网医疗作为传统医疗服务和现代互联网信息技术的跨界融合,正如雨后春笋般的在当下互联网革命与社会变迁的浪潮中迅速崛起。目前国家政策导向、互联智能广泛应用、健康医疗市场需求、社会资本介入等齐为互联网医疗发展推波助澜。基于我国国情以及政策进程、公众认知差异等因素,冲破互联网医疗发展的藩篱依旧面临着重重困阻,运用ROCCIPI技术厘清我国互联网医疗发展遇到的阻碍和问题并进行分析。     

试析多学科专家组诊疗模式与区域医疗中心的建立

多学科专家组诊疗（Multidisciplinary Team,MDT）模式已成为肿瘤治疗的模式和发展方向,但我国的MDT模式还仅限于建立在发达地区少数医院。新医改已将区域医疗的建设列为重点内容,这将促进我国肿瘤的规范化治疗,MDT也将借助于区域医疗中心这一平台进行延伸和扩大,改变我国MDT模式发展滞后的现状。