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。     

台湾地区全民健保下分级诊疗制度之借鉴

借鉴我国台湾地区全民健保下分级诊疗制度,落实和完善现行分级诊疗制度以保证医疗资源的合理配置。利用文献分析,对比研究两岸不同卫生体制下分级诊疗制度实施现状,结合专家访谈的形式明确台湾分级诊疗制度的特点。通过建立短期医疗网计划、成立社区医疗群、改革医保补偿机制、构筑医联体等方式优化分级诊疗制度。     

中国与澳大利亚医疗各项卫生保障制度的对比研究

通过对中澳两国的现行的医疗保障制度的对比分析,结合我国现阶段医疗卫生发展的现状,从不同的视角探讨分析我国现行的医疗保障制度。由于受宏观经济制度的制约和影响,加之我国的地域特点是南北跨度大,经济、文化等区域发展不均衡,我国的医疗保障制度中存在着诸多的问题：保障制度总体水平不高,人群待遇差距较大;适应流动性方面不足;保证可持续性方面不足等。我国借鉴和吸收了国外的先进经验,建立了全民可及的、人人享有的医疗保障制度,但就如何进一步完善我国现行的各项医疗保障制度,推进我国的医疗卫生事业的不断发展,提出了相应的对策及建议：建立完善的、可持续性的卫生服务体制;借鉴澳大利亚的成功经验,结合我国的国情,加大资金投入,简化报销流程,不断完善我国现代医疗保障制度;加强全科医生的培养,可以在一定程度上解决”看病难、看病贵”的问题。完善我国现代医疗保障制度是一个关系到国计民生的、复杂的、系统的大工程。我国的医疗卫生保障制度的改革面临着巨大的挑战,只有加快经济发展的步伐,借鉴和吸收更多国外成功的经验,不断完善我国的医疗保障制度,才能最终实现全民可及的、免费医疗的卫生保障制度。     

健康中国背景下构建全民医保制度的策略探析

全民医保制度通过对人群健康的维护功能助力健康中国的实现,现行医保制度虽然实现了人群的广覆盖,但与全民医保制度还存在较大差距,阻碍来源于体系的分裂、与社会发展需求的不适应及外部环境对全民医保制度的阻力。针对当前问题,文章提出以医疗保险向健康保险转型为总体方向,统筹管理为根本、完善功能为关键、促进三医联动为助动力的全民医保制度构建策略。     

从医疗设备的引进看二十年的医院发展

医院医疗仪器设备,是医疗、教学、科研的物质基础,也是提高医疗质量和服务质量,提高医院整体经济技术实力的重要前提和基本条件.因此大型先进医疗设备的引进,不仅是医院自身发展的客观要求,也是提高全民素质的有力保障。     

台湾地区全民健保总额预算制度设计与运行效果评述

总额预算制作为医保对供方主要支付方式之一在国际上得到广泛应用,我国的上海、北京等地区也开始在不同程度上通过总额预算方式实现支付方式改革。总额预算作为一种控制医疗费用过快增长的方式既有优势也存在弊端。以我国台湾地区为例,介绍总额预算制度的运行机制和总额制定方式,并探讨总额预算制的实施效果,分析总额预算达到效果最优化的制度设计,为改革提供政策借鉴。     

浅谈对中学生物实验教学的认识

生物学是一门以实验为基础的学科,实验教学在课堂教学中占有极其重要的地位。中学生物实验教学是全面落实生物教学大纲和提高生物课教学质量的重要环节,是加强实践教育的重要内容。它对提高全民素质,推动生物课的教学改革有着重要的意义。     

国家公园全民公益性评估指标体系:以青藏高原国家公园群为例

全民公益性是我国国家公园建设需坚持的三大理念之一,但受其内涵不明确且缺乏有效考核评价机制的制约,尚未受到相关方的充分重视。建立一套能准确反映其内涵的指标体系,用于评估国家公园全民公益性理念执行成效、引导相关方采取针对性措施提高国家公园的全民公益性具有重要意义。本研究在梳理国外主要国家公园全民公益性的内涵和具体体现,分析我国国家公园建设的时代背景和独有特征的基础上,剖析了我国国家公园全民公益性的内涵和逻辑构成。在此基础上,通过深入实地考察,建立了青藏高原国家公园群全民公益性评估备选指标体系,利用Delphi法,以发放电子问卷的形式对本领域14名知名专家开展两轮咨询,从拟定的全民公益性评估备选指标体系中筛选指标,结合问卷咨询结果建立了包括管理者、社区居民、相关企业和社会组织、游客和公众5个方面,涉及5个一级指标、17个二级指标和35个三级指标的青藏高原国家公园群全民公益性评估指标体系。指标体系囊括了国家公园体制机制、社区民生福祉、企业和社会组织参与、访客体验、公众参与等方面的多个内容。针对青藏高原的实际情况,还设置了医疗保障体系、应急救援体系等指标,并考虑在实际评估中增加相关指标权重,更加...     

以随机系数模型衡量内视镜胆囊切除手术成本管理绩效

使用随机系数模型估计医疗组织成员的学习率,衡量组织学习的绩效,并且实证性地采用中国台湾地区全民健康保险数据库,比较台湾医学中心医院对内视镜胆囊切除手术成本控制的学习绩效。通过研究的理论性与实证性,组织管理者可以从微观的角度了解到组织内部的学习能力与不同团体和组织之间的学习率差异。     

上海黄浦区社区卫生服务绩效评价与SWOT分析

公立医院规划布局是卫生资源配置极为最重要的一个环节。公立医院的合理配置、优化布局有助于提高医疗资源运行效率,使居民获得最大健康产出。从系统角度出发,要更好地配置公立医院资源,必须更好地发挥公立医院与社区卫生服务机构的协同作用,建立有序的分级诊疗模式。因此,文章结合全民健康覆盖的四个条件,对上海市黄浦区社区卫生服务作绩效评估与SWOT分析,为社区卫生服务的进一步发展提供建议,也为更好地配置公立医院资源提供参考。     

Virtual health care center in Georgia

Application of telemedicine systems to cover distant geographical areas has increased recently. However, the potential usefulness of similar systems for creation of national networks does not seem to be widely appreciated. The article describes the "Virtual Health Care Knowledge Center in Georgia" project. Its aim was the set up of an online integrated web-based platform to provide remote medical consultations and eLearning cycles. The project "Virtual Health Care Knowledge Center in Georgia" was the NATO Networking Infrastructure Grant dedicated for development of telemedicine in non-NATO countries. The project implemented a pilot to organize the creation of national eHealth network in Georgia and to promote the use of innovative telemedicine and eLearning services in the Georgian healthcare system. In June 2007 it was continued under the NATO Networking Infrastructure Grant "ePathology--Virtual Pathology Center in Georgia as the Continuation of Virtual Health Care Center".     

African Female Physicians and Nurses in the Global Care Chain: Qualitative Explorations from Five Destination Countries

Migration of health professionals is an important policy issue for both source and destination countries around the world. The majority of migrant care workers in industrialized countries today are women. However, the dimension of mobility of highly skilled females from countries of the global south has been almost entirely neglected for many years. This paper explores the experiences of high-skilled female African migrant health-workers (MHW) utilising the framework of Global Care Chain (GCC) research. In the frame of the EU-project HURAPRIM (Human Resources for Primary Health Care in Africa), the research team conducted 88 semi-structured interviews with female and male African MHWs in five countries (Botswana, South Africa, Belgium, Austria, UK) from July 2011 until April 2012. For this paper we analysed the 34 interviews with female physicians and nurses using the qualitative framework analysis approach and the software atlas.ti. In terms of the effect of the migration on their career, almost all of the respondents experienced short-term, long-term or permanent inability to work as health-care professionals; few however also reported a positive career development post-migration. Discrimination based on a foreign nationality, race or gender was reported by many of our respondents, physicians and nurses alike, whether they worked in an African or a European country. Our study shows that in addition to the phenomenon of deskilling often reported in GCC research, many female MHW are unable to work according to their qualifications due to the fact that their diplomas are not recognized in the country of destination. Policy strategies are needed regarding integration of migrants in the labour market and working against discrimination based on race and gender.     

Modelling Conditions and Health Care Processes in Electronic Health Records: An Application to Severe Mental Illness with the Clinical Practice Research Datalink

Background

The use of Electronic Health Records databases for medical research has become mainstream. In the UK, increasing use of Primary Care Databases is largely driven by almost complete computerisation and uniform standards within the National Health Service. Electronic Health Records research often begins with the development of a list of clinical codes with which to identify cases with a specific condition. We present a methodology and accompanying Stata and R commands (pcdsearch/Rpcdsearch) to help researchers in this task. We present severe mental illness as an example.

Methods

We used the Clinical Practice Research Datalink, a UK Primary Care Database in which clinical information is largely organised using Read codes, a hierarchical clinical coding system. Pcdsearch is used to identify potentially relevant clinical codes and/or product codes from word-stubs and code-stubs suggested by clinicians. The returned code-lists are reviewed and codes relevant to the condition of interest are selected. The final code-list is then used to identify patients.

Results

We identified 270 Read codes linked to SMI and used them to identify cases in the database. We observed that our approach identified cases that would have been missed with a simpler approach using SMI registers defined within the UK Quality and Outcomes Framework.

Conclusion

We described a framework for researchers of Electronic Health Records databases, for identifying patients with a particular condition or matching certain clinical criteria. The method is invariant to coding system or database and can be used with SNOMED CT, ICD or other medical classification code-lists.     

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。     

Review essay

Rationing Health Care in America:Perceptions and Principles of Justice by Larry R. Churchill. American Health Care:Realities, Rights, and Reforms by Charles J. Dougherty. Should Medical Care Be Rationed by Age? edited by Timothy M. Smeeding, with Margaret P. Battin, Leslie P. Francis, and Bruce M. Landesman, Totowa, N.J., Rowman and Littlefield.     

Advances in the Conceptualization and Measurement of Health Care Empowerment: Development and Validation of the Health Care Empowerment Inventory

The Health Care Empowerment Model offers direction for the investigation of patient-controlled engagement and involvement in health care. At the core of the model is the construct of Health Care Empowerment (HCE), for which there exist no validated measures. A set of 27 candidate self-report survey items was constructed to capture five hypothesized inter-related facets of HCE (informed, engaged, committed, collaborative, and tolerant of uncertainty). The full item set was administered to 644 HIV-infected persons enrolled in three ongoing research studies. Exploratory and confirmatory factor analyses resulted in a two factor solution comprising four items each on two subscales: (1) HCE: Informed, Committed, Collaborative, and Engaged HCE ICCE) and (2) HCE Tolerance of Uncertainty (HCE TU). Subscale scores were evaluated for relationships with relevant constructs measured in the three studies, including depression, provider relationships, medication adherence, and HIV-1 viral load. Findings suggest the utility of this 8-item Health Care Empowerment Inventory (HCEI) in efforts to measure, understand, and track changes in the ways in which individuals engage in health care.     

Threshold Conditions for West Nile Virus Outbreaks

In this paper, we study the stability and saddle-node bifurcation of a model for the West Nile virus transmission dynamics. The existence and classification of the equilibria are presented. By the theory of K-competitive dynamical systems and index theory of dynamical systems on a surface, sufficient and necessary conditions for local stability of equilibria are obtained. We also study the saddle-node bifurcation of the system. Explicit subthreshold conditions in terms of parameters are obtained beyond the basic reproduction number which provides further guidelines for accessing control of the spread of the West Nile virus. Our results suggest that the basic reproductive number itself is not enough to describe whether West Nile virus will prevail or not and suggest that we should pay more attention to the initial state of West Nile virus. The results also partially explained the mechanism of the recurrence of the small scale endemic of the virus in North America. Supported by the Chinese NSF grants 10531030 and 10671143. Supported by the Chinese NSF grants 10801074. Supported by Canada Research Chairs Program, Mathematics for Information Technology and Complex Systems (MITACS), National Microbiology Laboratory, Natural Sciences and Engineering Research Council (NSERC), Canadian Foundation of Innovation (CFI) and Ontario Innovation Trust (OIT), Ontario Ministry of Health and Long-term Care, Peel, Toronto, Chat-Kent Health Units, and Public Health Agency of Canada (PHAC). Supported by NSERC, MITACS, CFI/OIT a new opportunity fund, Early Research Award of Ministry of Research and Innovation (ERA) of Ontario, Infectious Diseases Branch of Ministry of Health and Long Term Care (MOH) of Ontario and PHAC.     

American Indian Health: Innovations in Health Care, Promotion, and Policy

American Indian Health: Innovations in Health Care, Promotion, and Policy. Everett R. Rhoades. M.D., ed. Baltimore: Johns Hopkins University Press, 2000. xxiii. 459 pp.