基于公益性的我国公立医院运行机制分析

公立医院的改革试点及其医疗服务水平的提高,是当下我国医药卫生体制改革的重点之一,对于解决群众“看好病”的问题有着深远意义。从我国公立医院发展与运作的现状出发,剖析公立医院公益性淡化的各种因由;针对公立医院运行中存在的突出问题,提出基于公益性的公立医院运行机制分析框架;结合我国医药卫生事业改革工作的主要内容,以我国公立医院公益性为主旨,浅析医疗资源配置、医疗合理定价以及药品事业管理改革等相关重要问题。     

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。     

非营利性公立医院改革：弱势群体的医疗服务

我国政府举办的公立医院属于非营利性质,文章在分析我国非营利性公立医院现状的同时,比较了国内外弱势群体医疗服务政策的差异,对比认为政府应该承担起对弱势群体医疗服务的责任,并提出建立以弱势群体为主要服务对象的非营利性公立医院。以非营利性公立医院为载体来解决弱势群体“看病难、看病贵”的问题具备一定的理论依据,在具体实践中需要从多个方面加强非营利性公立医院的改革与完善。     

公立医院公益性及其改革问题的重新审视

医药卫生体制改革系列政策出台后，公立医院“回归公益性”问题成为理论界关注和探讨的热点，并为公立医院管理者提出了严峻的挑战。文章重新审视我国公立医院的界定、公益性和改革的核心、方向问题，阐述公立医院改革的核心和方向不在于公益性回归，而在于公益性和社会责任的有效实现形式的改革创新和探索，以此为新医改背景下公立医院改革提供借鉴参考。     

我国公立医院病人安全文化的现状研究

目的 构建适合我国公立医院的病人安全文化测评量表,并分析我国公立医院病人安全文化现状。方法 对我国东、中、西部3省（直辖市）54所公立医院员工进行问卷调查。结果 中国版医疗机构病人安全文化调查量表信、效度可以接受;我国公立医院病人安全文化处于中上水平（总体平均分为3.80分）;在“害怕受责备与惩罚”“害怕受羞辱”“提供安全的医疗保健”和“组织安全资源”的维度上,评分相对较低;不同地区、等级公立医院病人安全文化存在一定差异。结论 我国公立医院病人安全文化尚未达到令人满意的程度,政府卫生主管部门和医院管理者需要营造更好的病人安全文化,尤其应加强西部地区医院和二级医院的病人安全文化建设。     

基于多机制框架的县级公立医院补偿机制设计

县级公立医院补偿机制的设计不单纯是一个财务的平衡问题,涉及政府、医保、医院、价格等多方面的机制协调。以公立医院补偿机制改革的经验借鉴为出发点,总结了县级公立医院补偿机制设计的基本逻辑和“多机制框架”。依据激励相容理论,对“多机制框架”下的县级公立医院补偿机制进行了系统设计。     

湖北省公立医院公益性实现情况调查分析

目的 了解湖北省公立医院运行现状,分析影响公立医院公益性实现的因素,从而挖掘百姓“看病贵”的深层次原因。方法 随机抽取湖北省6家公立医院进行现场调查,并结合相关统计资料进行分析。结果 湖北省公立医院在参与突发卫生事件救治、医疗救助、“三支”等非常规公益性活动的力度逐年增强,但是宏观经济体制和卫生政策的变革,不合理的激励分配机制,使公立医院全面、持久地实施公益性面临很多困难。结论 解决百姓“看病贵” 的问题还需要相关部门共同努力。     

公立医院管理体制改革探析

为了弄清什么是公立医院的管理体制,公立医院管理体制改革的对象是什么等问题,通过系统阅读和整理若干文献, 认为：公立医院管理体制改革不是简单的“管办分开”,其本身并非改革的目的,而只是完善公立医院管理体制的手段;也不等于单纯地建立医院管理理事会。改革我国公立医院陈旧落后的管理体制就是要做到：在公立医院的外部治理上,转变政府职能,实现政府的宏观规划监管职能与微观经营管理职能分开,让医院获得经营管理的自主权;在公立医院的内部治理上,建立以医院管理理事会为核心的法人治理结构,在公立医院拥有充分自主权的前提下,实现公立医院的决策权、执行权与监督权的独立与相互制衡。     

基于“模拟转编”的医务人员同工同酬改革实践

我国公立医院同工不同酬的现象严重影响医务人员的积极性。湖北医药学院附属人民医院对聘用合同制员工采取择优“模拟转编”的改革方式,初步构建了医务人员同工同酬的分配机制,深化了公立医院内部运行机制改革,在调动医务人员的积极性方面取得显著成效。     

公立医院法人治理结构与改革

随着国务院医改近期重点实施方案的出台,公立医院法人治理结构的改革模式也渐渐明朗。公立医院法人治理结构改革是创新公立医院体制机制的关键任务之一,是维护公立医院公益性的重要制度保障。针对公立医院法人治理结构的内涵作了阐述,从公立医院的多层委托代理关系、产权制度等多角度分析了我国公立医院法人治理结构的现状和问题,提出了我国公立医院法人治理结构改革的具体措施。     

Analysis of potential phosphorylation sites in human T cell leukemia virus type 1 Tax

The human T cell leukemia virus type 1 (HTLV-1) Tax is a phosphoprotein, however, the contribution of phosphorylation to Tax activity is unknown. Previous studies have shown that phosphorylation of Tax occurs on serine residue(s), within one tryptic fragment, in response to 4-phorbol-12-myristate-13-acetate, in both mouse and human cells. Studies were conducted in multiple cell lines to identify the specific phosphorylated serines as a prelude to functional analysis. The phosphorylation pattern of Tax was found to be different in 293T and COS-7 cells in comparison with MT-4 and Px-1 cells. However, one tryptic fragment remained consistent in comigration analyses among all cell lines. Using selected Tax serine mutants a tryptic fragment containing a serine at residue 113 believed to be the site of phosphorylation of Tax did not comigrate with the common phosphorylated tryptic fragment. Analysis of selected Tax mutants for ability totrans-activate the cytomegalovirus promoter demonstrated mutation of serine 77 to alanine reducedtrans-activation by 90% compared to wild-type Tax. However, examination of the phosphorylation pattern of the serine 77 mutant demonstrated that it is not the site of phosphorylation. These studies demonstrate the importance of using relevant cell lines to characterize the role of phosphorylation in protein function.     

公立医院公共卫生服务补偿中存在的问题与对策研究

公立医院作为公共卫生体系中不可或缺的一个部分, 在公共卫生体系中起着重要的支撑作用。然而对于公立医院公共卫生服务的补偿问题一直以来都没有得到合理、有效的解决。分析了当前我国公立医院公共卫生服务补偿中存在的问题,并对进一步完善公立医院公共卫生服务补偿机制提出了相应的建议和对策。     

我国公立综合性医院战略定位类型研究

借鉴经营战略相关理论,结合我国特点,从业务定位、市场定位和竞争态势定位对我国公立综合性医院的战略定位分类进行了研究。通过对我国东、中、西三省/直辖市公立综合性医院的抽样调查,课题组将其战略定位分为5类,并分析了5类战略定位在公立综合性医院中的分布。     

Tax1 binding protein 3 regulates osteogenic and adipogenic differentiation through inactivating Wnt/β-catenin signalling

Tax1 binding protein 3 (Tax1bp3) is a PDZ domain-containing protein that is overexpressed in cancer. Previous studies recognized Tax1bp3 as an inhibitor of β-catenin. Till now it is not known whether Tax1bp3 regulates osteogenic and adipogenic differentiation of mesenchymal progenitor cells. In the current study, the data showed that Tax1bp3 was expressed in bone and was increased in the progenitor cells when induced toward osteoblast and adipocyte differentiation. The overexpression of Tax1bp3 in the progenitor cells inhibited osteogenic differentiation and conversely stimulated adipogenic differentiation, and the knockdown of Tax1bp3 affected the differentiation of the progenitor cells oppositely. Ex vivo experiments using the primary calvarial osteoblasts from osteoblast-specific Tax1bp3 knock-in mice also demonstrated the anti-osteogenic and pro-adipogenic function of Tax1bp3. Mechanistic investigations revealed that Tax1bp3 inhibited the activation of canonical Wnt/β-catenin and bone morphogenetic proteins (BMPs)/Smads signalling pathways. Taken together, the current study has provided evidences demonstrating that Tax1bp3 inactivates Wnt/β-catenin and BMPs/Smads signalling pathways and reciprocally regulates osteogenic and adipogenic differentiation from mesenchymal progenitor cells. The inactivation of Wnt/β-catenin signalling may be involved in the reciprocal role of Tax1bp3.     

Control Costs,Enhance Quality,and Increase Revenue in Three Top General Public Hospitals in Beijing,China

Background

With market-oriented economic and health-care reform, public hospitals in China have received unprecedented pressures from governmental regulations, public opinions, and financial demands. To adapt the changing environment and keep pace of modernizing healthcare delivery system, public hospitals in China are expanding clinical services and improving delivery efficiency, while controlling costs. Recent experiences are valuable lessons for guiding future healthcare reform. Here we carefully study three teaching hospitals, to exemplify their experiences during this period.

Methods

We performed a systematic analysis on hospitalization costs, health-care quality and delivery efficiencies from 2006 to 2010 in three teaching hospitals in Beijing, China. The analysis measured temporal changes of inpatient cost per stay (CPS), cost per day (CPD), inpatient mortality rate (IMR), and length of stay (LOS), using a generalized additive model.

Findings

There were 651,559 hospitalizations during the period analyzed. Averaged CPS was stable over time, while averaged CPD steadily increased by 41.7% (P<0.001), from CNY 1,531 in 2006 to CNY 2,169 in 2010. The increasing CPD seemed synchronous with the steady rising of the national annual income per capita. Surgical cost was the main contributor to the temporal change of CPD, while medicine and examination costs tended to be stable over time. From 2006 and 2010, IMR decreased by 36%, while LOS reduced by 25%. Increasing hospitalizations with higher costs, along with an overall stable CPS, reduced IMR, and shorter LOS, appear to be the major characteristics of these three hospitals at present.

Interpretations

These three teaching hospitals have gained some success in controlling costs, improving cares, adopting modern medical technologies, and increasing hospital revenues. Effective hospital governance and physicians'' professional capacity plus government regulations and supervisions may have played a role. However, purely market-oriented health-care reform could also misguide future healthcare reform.     

我国公立医院财政长效补偿机制实现方式探讨

通过对公立医院财政长效补偿机制概念的阐述,分析了公立医院补偿机制的现状及问题,并提出了完全实现社会功能的公立医院、待实现社会功能的公立医院和待转型的公立医院三种补偿机制,以期对我国公立医院财政长效补偿机制的实现提供参考依据。     

北京市公立医院管理人员职业化培训需求调查

目的 了解北京市公立医院管理人员的职业化需求,为设置针对性的培训课程体系提供依据。方法 按照分层整群抽样的方法,从北京市10家公立医院中抽取628名管理人员,发放自编“北京市公立医院管理人员职业化培训调查问卷”。结果 （1）调查对象中87.10%认为医院管理人员应从“医学专家型”向“医院管理型”转变, 51.59%表示不愿意全职从事管理工作;（2）医院管理人员有97.13%表示愿意参加管理培训课程,并对培训课程的内容、形式、时间、师资等提出了具体化的要求。结论（1）北京市公立医院管理人员具备职业化意识但职业化意愿不强,应建立完善的长效激励机制以增加管理岗位的吸引力;（2）北京市公立医院管理人员参加管理职业化培训的需求较强,应设置针对性的培训课程体系来提高其管理水平。

     

Damaged DNA and miscounted chromosomes: human T cell leukemia virus type I tax oncoprotein and genetic lesions in transformed cells

Genetic instability is a recurring theme in human cancers. Although the molecular mechanisms mediating this effect commonly observed in transformed cells are not completely understood, it has been proposed to involve either the loss of DNA repair capabilities or the loss of chromosomal stability. The transforming retrovirus human T cell leukemia virus type I (HTLV-I) encodes a viral oncoprotein Tax, which is believed to cause the genomic instability characteristic of HTLV-I-infected cells. This review focuses on the ability of HTLV-I Tax to disrupt the cellular processes of DNA repair and chromosomal segregation. The consequences of these effects as well as the evolutionary advantage this may provide to HTLV-I are discussed.