 |
|
|
共查询到20条相似文献，搜索用时 343 毫秒
1.
对江苏省3种基本医疗保险支付方式改革探索作出分析,分别介绍了在城镇职工基本医疗保险支付方式上,淮安市实行的"病种分值结算办法"、镇江市实行的"总额预算、弹性结算、部分疾病按病种付费";在城镇居民基本医疗保险支付方式上,南京市实行的部分病种定额指标结算,住院医疗费用控制指标结算、连云港实行的问题控制结算办法;在新型农村合作医疗支付方式上,积极探索单病种定额付费等,并对支付方式改革取得的效果作了比较深入的分析。 相似文献
2.
??????? 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。 相似文献
3.
目的
分析宁夏银川市三级甲等医院职工基本医疗保险总额预付制的基本运行情况以及综合实施效果变化,为更好的实施总额预付制提供合理的建议。 方法 对7家三甲医院2012年以及2013年的出院人次、次均费用、次均医保支付、非医保支付指标进行统计对比,运用秩和比法综合评价7家三甲医院总额预付制实施的效果。 结果 2013年7家三甲医院一共透支了34.88%,2013年较2012年次均费用、次均医保支付、非医保支付比例均呈现增长趋势,次均医保支付增长幅度与次均费用增长幅度不成比例,而且次均医保支付增长均远远高于次均费用增长。宁夏人民医院和宁夏医科大总院心脑血管病医院的RSR值小幅度增加,其余5家三甲医院的RSR值均降低。 结论 7所三甲医院透支严重,医院承担很大超支的风险和压力,对医院的正常运营会有影响。总体来看,政策没有有效的控制医疗费用的增长,总额预付制的综合运行效果不明显。增强医保中心对医院的管理,医院内部要实行“总额控制、结构调整”的管理,健全信息系统,加强监督与管理。 相似文献
4.
目的 分析农村儿童先天性心脏病医疗保障试点工作运行效果。 方法 运用SPSS17.0软件对湖北省A县先天性心脏病住院患儿就医费用及补偿数据进行分析。 结果 先天性心脏病患儿实际补偿比低于新农合全体患者,患者负担沉重;支付方式改革有效控制了费用增长,定额支付标准能够引导供方诊疗行为;支付方式改革可能出现了人为加重诊断的负面效应。 结论 逐步扩大重大疾病保障的病种覆盖范围,采用混合式的补偿模式,科学疾病分类、制定和调整单病种定额支付标准,针对支付方式改革可能产生的负面效应针对性地加强医疗机构监管。 相似文献
5.
?????? 目的
评价我国医疗保险规制效果,筛选优先干预措施,为建立有效的医院规制体系提供依据。 方法 运用文献研究法明确现行医疗保险规制策略,通过问卷调查法调查策略实施情况,运用加权TOPSIS综合评价法对医疗保险规制的主要策略进行多维度综合评价。 结果 医疗保险支付方式是下一步规制改革的首要内容,接下来依次为医疗保险定点机构管理及医疗保险筹资和费用补偿。 结论 在促进后付制（按项目付费）向预付制转变的同时,积极探索多种支付方式的结合运用。 相似文献
6.
通过对美国在联邦医疗保险体系中实行的不同薪酬支付方式（按绩效支付、按治疗事件支付、责任性医疗组织、以患者为中心的医疗之家）及美国薪酬体系改革几种模式的介绍，了解各种支付方法改革的目的、形式和具体实施中存在的问题，以期对我国的公立医院薪酬制度改革提供参考。 相似文献
7.
目的 分析县级公立医院医保支付方式改革实施现状，发现问题并提出对策。 方法 通过邮寄问卷与实地调研的方法收集数据，采用SPSS19.0对数据进行运算处理与分析。 结果 参与山东省第一、二批县级公立医院改革的医疗机构中160家（92.5%）进行了医保支付方式改革，但支付方式仍较单一；开展按病种限价付费与按病种定额付费的医院中，病种数量超过50种的分别占26.2%、11.4%；63.8%的医疗机构考核结果与医保支付挂钩等。 结论 应推行复合型付费方式，增加按病种付费的病种数量，克服医保支付方式改革推行过程中来自“医、保、患”三方的阻力，发挥支付方式对医疗机构的正向引导作用。 相似文献
8.
按病种付费作为控制医疗费用过快上涨的一项支付方式改革,在我国的进展较为缓慢且改革效果未及预期,主要原因之一是来自医生的阻力。本研究借用委托代理理论分析医生作为代理方在执行按病种付费改革过程中,如何利用自己的信息优势而采取机会主义行为,产生隐藏特征问题如何对改革的进展和效果起到阻碍作用,为进一步完善按病种付费制度提供参考建议。 相似文献
9.
目的
通过多种形式的新农合支付方式改革,提高参保人群的受益程度,有效控制患者住院均次费用的不合理增长,促进医疗机构内部运行机制的转变,提高医保资金的使用效率。 方法 采集不同类别的医疗机构,不同支付方式的住院均次费用的增幅数据,进行改革前后的数据分析。 结果 改革前后各级各类医院住院均次费用的逐年增幅差距很大,利用支付方式综合改革后的各级各类医疗机构患者住院均次费用得到控制。 结论 多种形式的支付方式改革是影响医疗机构内部运行机制、降低住院均次费用增幅的有效手段。 相似文献
10.
目的
了解银川市定点医疗机构总额预付制的实施效果,在此基础上探究总额预付制下不同方式下医保基金的控制与管理。 方法 采用定性分析与定量分析相结合的方法,采用SPSS软件对数据进行分析,采用病例组合方法进行改进方法研究。 结果 银川市总额预付制实施后费用控制效果不明显,次均费用等指标呈现上升趋势,同时也发现实施方案中存在一些问题。 结论 针对总额预付实施方案中出现的问题,提出以病例组合平均费用作为总预付方案,控制费用的同时合理利用医疗资源,促进病人合理分流。 相似文献
11.
首都医科大学附属北京世纪坛医院承担了“京医通二期”项目试点工作。项目主要目标是在不改变医保卡介质使用的前提下,让医保患者可以方便使用京医通支付体系,持一张医保卡即可完成在医生诊间、自助终端的便捷支付。同时,借助互联网应用建立京医通微信公众服务号,实现医保及京医通全人群患者在手机微信端进行预约挂号,就诊导诊等功能。试点项目投入使用后,使患者平均在院滞留时间减少16.7分钟,提升了患者就诊体验。以项目建设实践为基础,介绍了整个项目的系统架构设计、医疗机构对接方式、目前系统实现的功能、应用效果等内容,并结合项目建设规划总结项目建设的意义及存在的问题。 相似文献
12.
目的 调查上海市实行医疗保险总额预付的三级医院中患者的就医感受。 方法 经培训的调查员应用结构式调查问卷对上海市10家实行医疗保险总额预付的三级医院的699名患者进行面对面访谈，数据分析主要采用描述性统计。 结果 城保患者对门诊医生明显减少处方金额（或处方天数）的感受强于非城保患者，城保和非城保患者的住院就医感受差异无显著统计学意义。 结论 医疗保险总额预付对上海三级医院患者就医感受的总体效应似偏弱，而且有限的影响主要集中于门诊而非住院环节。 相似文献
13.
总结了我国公立医院改革的进程,分析了进行公立医院改革绩效评价的必要性,然后设计了公立医院改革逻辑模型,最后对公立医院改革绩效评价的目标、原则和主要内容进行了讨论。 相似文献
14.
单病种支付作为一种合理控制医疗服务费用的方式,对医疗机构的行为有重要影响。调查显示,支付方案多采取最高限价和定额补偿相结合的方式,基层医院、民营医院执行的主动性相对较高,财务收入增高,诊疗质量也有改善。参合人员实际受益有限,遵循临床路径率不高,支付标准的设计不尽合理,大医院执行的动力不足。建议合理确定单病种支付标准,以乡镇卫生院、专科医院为实施重点,逐步推进到三级综合医院;建立质量与费用监控的指标体系、科学的考核和评价机制。 相似文献
15.
EU-LIFE, which represents 10 European life science research institutes, has reopened the debate about how to fund research at the European level by calling for the budget of the European Research Council to be drastically increased.For more than a decade, European scientists have lobbied policy makers in Brussels to increase European Union (EU) funding for research and to spend the money they do provide more efficiently. This debate eventually led to the establishment of the European Research Council (ERC) in 2007, which provides significant grants and does so on the sole criterion of scientific excellence—something for which the scientific community pushed. As such, there seemed to be consensus about how to judge and fund science at the European level, including in the debate about the EU''s Horizon 2020 funding scheme—the EU''s framework for research and innovation—which will spend €80 billion over the next seven years (2014–2020). The conclusion seemed to be that the ERC should continue to support basic research on the basis of excellence, whereas other parts of the programme would focus on large cooperative projects, improving the competitiveness of Europe and meeting societal challenges such as climate change and public health.But a new body called EU-LIFE—set up in May 2013—has reopened the debate about how to fund science and is campaigning for a greater focus on rewarding excellence, even at the expense of funding projects on the grounds of fairness or to correct imbalances between EU member states. EU-LIFE was founded by 10 institutions including the Centre for Genomic Regulation (CRG; Barcelona, Spain), the Institut Curie (Paris, France) and the Max Delbrück Centre (Berlin, Germany), partly to provide a collective voice for mid-sized research institutes in the life sciences that might lack influence on their own ( |
Open in a separate windowERC, European Research Council.But while claiming to speak for the cause of European research as a whole, EU-LIFE also has a specific remit to speak up for its own members, mostly mid-sized institutions that consider themselves poorly represented in the corridors of EU decision-making. “There are several reasons why we decided to start this initiative,” said Luis Serrano, Director of the Centre for Genomic Biology in Barcelona, Spain, one of the EU-LIFE founders. “First we see that institutes of research do not have a voice in Brussels as a group, unlike universities or international organizations like EMBL. While in many cases our goals will be similar, this is not always the case. Second, we think that there are excellent research institutes in Europe, at the same level as many top places in the USA, that do not have enough visibility due to their size. By coming together and offering similar standards of quality, we want to achieve critical mass and become attractive to PhD and post-doctoral fellows from all over the world who currently mainly go to the USA. Third we think that all EU-LIFE members have specific strengths and know-how on different aspects of the life sciences. By sharing our experiences we think we could improve the quality and competitiveness of all of us.”While few scientists or policy makers would argue with EU-LIFE''s aim to stimulate international collaboration and attract the best young researchers to Europe, not everyone agrees with the organization''s call to do so by distributing more funds via the ERC. Although the ERC is widely regarded as successful in encouraging excellence and ‘curiosity-driven'' research—as opposed to distributing funds purely equitably between member countries—Mark Palmer, director of international strategy at the UK Medical Research Council (MRC), which spent £759.4 million (about €900 million) on research in the financial year 2011/2012, questions whether the ERC should receive even more funding than it does at present: “We support excellence, but if you put all the resources into one sort of mechanism, you lack the visibility for reaching across countries to join together to do research,” he said. “So there is an advantage in having a mixed pot of funding. If you put too much money in the ERC it becomes so distorted that you haven''t got European added value. You might as well have left the money back home and done it through the normal mechanisms.”“If you put too much money in the ERC it becomes so distorted that you haven''t got European added value”The ERC itself felt it was inappropriate to comment on its own budget, but Ernst-Ludwig Winnacker, who served as its secretary general from 2007 to 2009, pointed out that while he agrees in principle with the Commission''s proposal to double the ERC''s budget under Horizon 2020, this will not guarantee that the number of suitable high-quality applicants for funding would double as well. “Let us not forget that we are talking about scientific excellence only,” Winnacker, now General Secretary of the Human Frontier Science Program, said. “I have often asked myself how much excellence of the level expected to get supported by the ERC do we have in Europe. Would we really be able to spend twice the amount of money at the same quality level as now? I doubt it.”Winnacker indicated therefore that the ERC budget should increase at a sustainable level that ensures that the quality of projects funded is maintained. He also highlighted another risk in focusing a growing proportion of funds through the ERC, which is that it might make other agencies envious.“I have often asked myself how much excellence of the level expected to get supported by the ERC do we have in Europe”Palmer, for the MRC, said that he agrees with the current level of proposed funding increase for the ERC, but argued that it is important to preserve other sources of funding that support large-scale programmes involving multiple institutions, especially in the life sciences. In particular, major clinical screening programmes call for huge samples of patients, in some cases from diverse populations, which requires international collaboration, irrespective of the individual excellence of the departments involved. “For example the EPIC [European Prospective Investigation into Cancer and Nutrition] cohort has been going 20 years with over 500,000 people across 10 different countries,” Palmer said. “That diversity is something that you have to do at the European level.” EPIC is the world''s largest study on the relationship between diet and lifestyle factors and chronic diseases: A total of 521,457 healthy adults, mostly aged 35–70, were enrolled in 23 centres in 10 countries between 1993 and 1999, and the study showed with high statistical confidence that a modest change in lifestyle can yield a massive gain in life expectancy [
1].There may be broad agreement that large projects in biomedical research require a European-wide approach. The argument, though, boils down to whether or not funds designated for research should be used as a way of building infrastructure or collaborative frameworks alongside excellence, rather than being subordinated to it. This is the belief—and to some extent the remit—of the European Science Foundation (ESF; Strasbourg, France), which has promoted networking and the dissemination of information among research teams whose work is already being funded by other agencies. Now this role has been passed to Science Europe, headquartered in Brussels, while the ESF is focusing on its public communication activities.EU-LIFE will seek to collaborate with both the ESF and Science Europe, according to Michela Bertero, Head of International and Scientific Affairs at CRG. “We are in contact with both initiatives. They operate at a higher science policy level and on a larger scale, and we want to engage with them as research stakeholders,” Bertero said.Yet while the organization agrees with the ESF that science should tackle societal challenges, EU-LIFE disputes that this is best done by grants awarded solely on the basis of large collaborative projects. “Excellence should always be at the forefront for awarding grants,” explained Serrano. “This does not mean that societal and industrial challenges should not be tackled. But if there is no expertise in an area, then instead of funding groups which are not competitive, money should be used to train and hire the right personnel.”By challenging Horizon 2020 to distribute more money on the basis of excellence rather than goals, EU-LIFE seems to have reopened the debate on how research funds should be spent and to what purpose. Others, however, are calling for some research money to be put towards infrastructure in regions with the potential for high-quality science, but which lack resources and laboratories. This has actually been acknowledged and catered for in Horizon 2020, according to Joanna Newman, Director of the UK Higher Education International Unit, a registered charity funded by various public bodies, which coordinates engagement between UK universities and international partners. “Excellence should be the main criterion for awarding research funding,” Newman said. “As this is public money, it would be unfair to the public to fund less excellent projects. However, there is also a responsibility to help other Member States to build research capacity. Horizon 2020 will include a cross-cutting ‘Spreading Excellence and Widening Participation'' programme line to address this, by funding the partnering of institutions and/or researchers with different grades of current research capacity.”One European player even argues that the EU should extend this policy to assist building infrastructure in developing countries. “Developed countries have a responsibility in helping capacity building in the field of research,” said Antoine Grassin, Directeur Général of Campus France, the country''s agency for promoting higher education and international mobility. “From that point of view, it may be very helpful for researchers from developing countries to be able to join the international scientific community, which may require financial help, such as grants.”“…if there is no expertise in an area, then instead of funding groups which are not competitive, money should be used to train and hire the right personnel”In the case of Europe, Newman pointed out that links between the Horizon Framework programme and the Structural Funds to improve infrastructure and research capabilities within regions will be stronger under the 2020 regime from 2014 to 2020 compared with the current Framework Programme 7. But this alignment between the allocation of funds designated for structural purposes and those granted for research purposes is precisely one of EU-LIFE''s main complaints about the Horizon 2020 programme—the resulting allocations are not always based on excellence.Furthermore, Winnacker argued that excellence does not mix well with other societal factors within a single programme, never mind an individual project. “If other parameters are included, politics would immediately interfere,” he said. “The ERC only survives because it has impeccable scientific standards, which politicians do not dare to touch without being ridiculed. There are enough programs in Horizon 2020, and elsewhere, like the structural funds, which can take care of regional and societal issues. These are of course important, but let''s face it, the real ‘disruptive'' innovations which create jobs only come from fundamental research.”According to Lieve Ongena, Science Policy Manager at the Free University of Brussels (VUB; Belgium), one of the EU-LIFE founding members, it is for these sorts of reasons that EU-LIFE wants to divert more funds to the ERC. “It''s clear that the ERC is an absolutely necessary funding source,” she said. “The scientists can bring their own ‘pet'' project without addressing any top down action lines agreed upon by the member states. In addition, the money provides sufficient critical mass for a sufficiently long time line: five years. Above all, the evaluation excellence is the ‘sole'' selection criterion, and thus by definition grantees will help to increase Europe''s competitiveness.” Ongena emphasized that EU-LIFE would draw the attention of decision-makers to the ERC whenever possible. “Ultimately, they hope to convince ERC President Helga Nowotny to increase the budget, which is today only 17% of the speculated Horizon 2020 budget.”… there is a broad consensus that research priorities have changed and that Horizon 2020 necessarily includes a greater societal dimensionThe view that the ERC should become Europe''s dominant funding agency is still open to debate, however, even among institutions committed both to excellence and to supporting research at a European level. The European Molecular Biology Laboratory (EMBL) in Heidelberg obtains funding from 20 member states and its Director General Iain Mattaj argues for the continued existence of multiple funding sources. “While recognizing the very important role of the ERC in European research funding, I find it essential that research continues to be supported by a diversity of mechanisms, both national and European,” he said. “In the case of Horizon 2020, these include funding for Research Infrastructures, Marie Sklodowska Curie (MSC) Actions that fund the training of young research fellows and research in the area of Health. In particular, EMBL has advocated increased funding not only for the ERC but also for MSC Actions and for Research Infrastructures.” However, within these programmes, Mattaj emphasized that excellence should also be the main criterion for awarding grants in every case.Meanwhile EU-LIFE also has a grander vision beyond funding to make Europe more competitive and attractive for research, according to Geert Van Minnebruggen, Integration Manager at VUB. “To keep Europe a competitive and attractive place for top scientists, we should be prepared to offer them similar budget categories as the US and China,” Van Minnebruggen said. “EU-LIFE sees it as one of its major tasks, through dialogue with policy makers, to create awareness of this necessity.”Palmer points out that attracting scientists from outside the EU is not just about money, but also about culture. “With a lab, the culture is pretty well English language now, people publish in English and apply for grants in English. That can be an inhibitor, both for scientists and their partners, in the case of countries where English isn''t the first language,” he said. This issue has been taken on board by EU-LIFE, according to Serrano: “All EU institutes should try to become more international, use English as the main speaking language, ensure competitiveness and external evaluations, recognize merit and support it, favour mobility, and be open to new ideas and initiatives.”Despite disagreements over funding mechanisms and targets, there is a broad consensus that research priorities have changed and that Horizon 2020 necessarily includes a greater societal dimension. “We''re interested now in health and demographic changes and wellbeing challenges, which is very different from how they were funding science under previous frameworks,” Palmer said. “It is very much driven by the economic situation, about citizens as patients, health delivery and how to be sure patients get access to treatment.”Ongena has similar views: “As responsible life scientists, EU-LIFE community members should do everything possible to drive basic and translational research forward and to translate findings into benefits for society,” she said. But she reiterated EU-LIFE''s position that all this should be done on the criterion of excellence only. It seems that the debates from the past decade about how to properly support research are not yet over.
相似文献