医疗保险预付费方式控制医疗费用的机制研究

医疗保险以控制医疗费用为重要职能,以预付费方式为主要手段。医疗保险预付费方式实际上是一种“定额”付费方式,以“超支自负和结余归己”的固定结算制度为控费机制。目前,部分地区的医保机构对医疗机构采取“超支分担、结余奖励”的弹性结算制度,部分地区对医疗机构采取“超支自负、结余归人”或“超支分担、结余归己”的半固定半弹性结算制度。这些结算制度不是“定额”付费方式,而且“限额”付费方式,原本是为了既控制医疗费用又防范医疗风险,结果是既不能控制医疗费用又不能防范医疗风险。     

关于建立医疗风险管理机制的研究

医疗纠纷及其引发的“医闹”、群体性事件已经成为影响我国医疗卫生事业发展和社会稳定的一个突出问题。通过分析医疗纠纷产生的原因,提出建立集医疗风险预警、医疗风险处置和医疗风险社会分担为一体的医疗风险管理机制的框架。     

基于因子分析与Borda序值法的医疗风险矩阵构建

目的 构建医疗风险矩阵,为应对和控制医疗风险的预警和控制提供科学的管理依据。方法 运用风险矩阵的管理理论,通过文献查阅、风险问卷分析和专家咨询法识别和衡量各类潜在医疗风险发生的概率及其潜在的损失程度,采用因子分析法初步确定医疗风险矩阵的风险结,进一步用Borda序值法对风险结的风险影响和风险概率进行量化评估。结果 本研究通过因子分析将医疗风险归为六个风险结：包括操作规范、药物使用、工作负荷、患方因素、沟通与协作、医疗风险管理。Borda序值排在第一位的风险结为工作超负荷风险,其次为操作不当风险和药物使用潜在风险,然后为不良医患沟通和医疗风险管理不到位,最后为患方风险。结论 应构建多维度、全过程的医疗风险管理机制,密切防控风险等级较高的潜在医疗风险因素,及时做出有效的预警和干预。     

《医疗质量管理办法》的亮点与局限

医疗质量直接关系到人民群众的健康权益和对医疗服务的切身感受。改进医疗质量,保障医疗安全,是我国卫生事业改革与发展的重要内容和基础。我国《医疗质量管理办法》已于2016年11月1日起正式实施。较先前的相关法规,该办法凸显诸多亮点：突破性建立了国家层面的管理体系,明确了管理责任主体,更加注重环节质量管理,强调了对于风险的防范,确定了监管主体和责任主体的法律责任,对于提升我国医疗质量管理、缓解紧张的医患关系及构建和谐社会有着深远的意义。但是尚存不足之处,应及时补充和完善相关制度,使之能够更好地指导我国医疗质量管理实践。     

利益相关者视角下的远程医疗发展策略研究

远程医疗是一个多维的复杂的系统,它涉及众多不同利益主体,包括政府、各级卫生行政部门、医院、医生、患者和软硬件企业等。本研究依据利益相关者理论,首先将远程医疗利益相关者进行分类,然后分析他们的利益诉求,最后提出促进远程医疗发展的有效策略。     

军队医院医疗质量管理存在的问题及对策

随着我国医疗体制改革的不断推进,医院面临着自身管理体系和管理方式的重要革新。在新形势下,如何保证医疗质量管理更加规范、管理体系更加完善是医院管理者普遍重视的问题。医疗质量是医疗技术和医疗服务的核心、是医院竞争力的实质、是医院发展的根本。医院医疗质量的水平直接影响着患者的受益程度,也影响着医院自身的声誉和效益。因此,加强医疗质量管理可以有效地保证患者的利益,提高医院竞争力,促进医院可持续发展。随着社会的发展、科技的进步、医学模式的转变及国防建设的需要,军队医院的职能和作用也发生了变化,其不仅为军人提供医疗服务,也为地方群众就医提供便利。军队医院的医疗质量管理直接关系着军人的健康保障,也影响着地方群众的治疗效果。本文通过分析军队医院医疗质量管理存在的问题提出相应的对策,部队医院医疗质量管理部门应与时俱进,顺应国家医药卫生体制改革的同时,着眼于未来发展,建立健全医疗质量管理体系,改进管理模式,从而提高医疗质量,创造更高的经济效益和社会效益,以实现科学的可持续发展。     

医疗风险预警及控制机制探讨

目前我国医疗纠纷及伤医事件频发，医疗风险预警及控制机制的不健全、医患沟通不畅及信任危机是造成这种冲突的主要原因。通过对医疗风险预警及控制机制的研究，为政府和医疗机构在减少医疗风险的发生上提供了干预措施和参考依据。     

医疗风险基金在医院财务管理中的应用

医疗风险无处不在已成为医疗界的共识,在当今商业医疗保险制度尚不健全的条件下,医院通过设立医疗风险基金,建立风险共担机制,增加医院主动进行风险预防和控制的能力,医疗风险基金应结合医院财务管理,规范核算、合理运用,并实行监督考核机制,确保医疗风险管理机制得以持续发展。     

部队医院医疗风险管理存在的问题及对策分析

目的:近年来,医疗纠纷屡见不鲜,其中不乏军队医院。为此,我们对目前部队医院的医疗风险管理情况进行分析,深入总结军队医院管理存在的问题,并提出相应的对策以加强部队医院医疗风险的防范工作。方法:采取调查问卷方法对10所部队医院的一线医护人员就医疗风险相关问题进行调查,并对结果进行分析。结果:工龄低于5年的医务人员发生医疗风险的比率高于工作5年以上的人员;外科和妇产科医疗风险发生率较高;三级甲等医院医疗风险管理体系较三级乙等更完善。医院的管理制度、医务人员的工龄、科室的设置、风险教育及工作量等均与医疗风险的发生有着密切的关系。结论:部队医院应建立健全的风险预警系统与评价体系,提高医院对医疗风险的管理能力。医务人员应加强风险意识和法制意识,重视医患沟通,以促进医患关系和谐,从而减少或避免医疗纠纷的发生。     

从公立医院角度探讨注册医师多点执业

阐述公立医院在实施医师多点执业过程中应注意的3对基本矛盾,同时探讨医师多点执业可能给公立医院带来的影响,并提出合理化建议：理清利益相关集团,建立风险分担机制;建立全方位的绩效考核体系,创造人才成长氛围;探索医疗集团化的多点执业,实现多赢局面;完善双向转诊机制,确保医疗安全。     

Trends in the Development of Ecological Risk Assessment and Management Frameworks

Ecological risk assessment and management have grown from a long history of assessment and management activities aimed at improving the everyday lives of humans. The background against which ecological risk assessment and management has developed is discussed and recent trends in the development of risk assessment and management frameworks documented. Seven frameworks from five different countries are examined. All maintain an important role for science, suggest adaptive approaches to decision-making and have well-defined analytical steps. Differences in approaches toward the separation of policy and science, the preference for management over assessment, the inclusion of stakeholders, the iterative nature of the analytical cycle, the use of decision criteria and economic information suggest considerable evolution in framework design over time. Despite the changes, no consensus on the design of a framework is apparent and work remains to be done on refining an integrative framework that effectively incorporates both policy and science considerations for environmental management purposes.     

美国、加拿大环境和健康风险管理方法

对目前美国和加拿大多个部门使用的风险评价与风险管理方法进行了全面回顾和综合分析,论述各种不同方法的特征,深入探讨各种管理方法的基础、利弊、使用经验,辨识环境、人类健康和职业健康风险综合方法中应该包含的要素,阐述风险管理目标的确定方法,以期为中国的环境风险管理提供经验。     

Research Stakeholders’ Views on Benefits and Challenges for Public Health Research Data Sharing in Kenya: The Importance of Trust and Social Relations

Background

There is increasing recognition of the importance of sharing research data within the international scientific community, but also of the ethical and social challenges this presents, particularly in the context of structural inequities and varied capacity in international research. Public involvement is essential to building locally responsive research policies, including on data sharing, but little research has involved stakeholders from low-to-middle income countries.

Methods

Between January and June 2014, a qualitative study was conducted in Kenya involving sixty stakeholders with varying experiences of research in a deliberative process to explore views on benefits and challenges in research data sharing. In-depth interviews and extended small group discussions based on information sharing and facilitated debate were used to collect data. Data were analysed using Framework Analysis, and charting flow and dynamics in debates.

Findings

The findings highlight both the opportunities and challenges of communicating about this complex and relatively novel topic for many stakeholders. For more and less research-experienced stakeholders, ethical research data sharing is likely to rest on the development and implementation of appropriate trust-building processes, linked to local perceptions of benefits and challenges. The central nature of trust is underpinned by uncertainties around who might request what data, for what purpose and when. Key benefits perceived in this consultation were concerned with the promotion of public health through science, with legitimate beneficiaries defined differently by different groups. Important challenges were risks to the interests of study participants, communities and originating researchers through stigmatisation, loss of privacy, impacting autonomy and unfair competition, including through forms of intentional and unintentional ''misuse'' of data. Risks were also seen for science.

Discussion

Given background structural inequities in much international research, building trust in this low-to-middle income setting includes ensuring that the interests of study participants, primary communities and originating researchers will be promoted as far as possible, as well as protected. Important ways of building trust in data sharing include involving the public in policy development and implementation, promoting scientific collaborations around data sharing and building close partnerships between researchers and government health authorities to provide checks and balances on data sharing, and promote near and long-term translational benefits.     

Types of Integration in Risk Assessment and Management,And Why They Are Needed

Risk-based decision making requires that the decision makers and stakeholders are informed of all risks that are potentially significant and relevant to the decision. The International Programme on Chemical Safety of the World Health Organization has developed a framework for integrating the assessment of human health and ecological risks. However, other types of integration are needed to support particular environmental decisions. They are integration of exposure and effects, of multiple chemicals and other hazardous agents, of multiple routes of exposure, of multiple endpoints, multiple receptors, multiple spatial and temporal scales, a product's life cycle, management alternatives, and socioeconomics with risk assessment. Inclusion of all these factors in an integrated assessment could lead to paralysis by analysis. Therefore, it is important that assessors be cognizant of the decision process and that decision makers and those who will influence the decision (stakeholders) be involved in planning the assessment to ensure that the degree of integration is necessary and sufficient.     

An Integrated Framework for Risk Management and Population Health

The traditional medical model of health and health policy development has focused on individuals and the role of medical care in preventing and treating disease and injury. Recent attention to health inequities and social determinants of health has raised the profile of population heath and evidence-based strategies for improving the health of whole populations. At the same time, risk science has emerged as an important new discipline for the assessment and management of risks to health. This article reviews historical developments in the fields of risk management and population health and proposes a joint population health risk management framework that integrates the key elements of both fields. Applying this integrated approach to managing population health risks will facilitate the development of evidence-based health policy. It will encourage a more systematic and comprehensive evaluation of population health issues and promote the use of a broader suite of interventions to reduce health risks and enhance population health status.     

Biotechnology as the engine for the Knowledge-Based Bio-Economy

Abstract

The European Commission has defined the Knowledge-Based Bio-Economy (KBBE) as the process of transforming life science knowledge into new, sustainable, eco-efficient and competitive products. The term “Bio-Economy” encompasses all industries and economic sectors that produce, manage and otherwise exploit biological resources and related services. Over the last decades biotechnologies have led to innovations in many agricultural, industrial, medical sectors and societal activities. Biotechnology will continue to be a major contributor to the Bio-Economy, playing an essential role in support of economic growth, employment, energy supply and a new generation

FP7 provides the research community with funding certainty over the next few years. One of the FP7 thematic priorities is dedicated to the strengthening the European knowledge-based bio-economy bringing together science, industry and relevant stakeholders from Europe and the rest of the world. The conditions are, therefore, favourable towards the sustainable development and deployment of biotechnologies as an engine for the knowledge-based bio-economy.     

Interactive learning and action: realizing the promise of synthetic biology for global health

The emerging field of synthetic biology has the potential to improve global health. For example, synthetic biology could contribute to efforts at vaccine development in a context in which vaccines and immunization have been identified by the international community as being crucial to international development efforts and, in particular, the millennium development goals. However, past experience with innovations shows that realizing a technology’s potential can be difficult and complex. To achieve better societal embedding of synthetic biology and to make sure it reaches its potential, science and technology development should be made more inclusive and interactive. Responsible research and innovation is based on the premise that a broad range of stakeholders with different views, needs and ideas should have a voice in the technological development and deployment process. The interactive learning and action (ILA) approach has been developed as a methodology to bring societal stakeholders into a science and technology development process. This paper proposes an ILA in five phases for an international effort, with national case studies, to develop socially robust applications of synthetic biology for global health, based on the example of vaccine development. The design is based on results of a recently initiated ILA project on synthetic biology; results from other interactive initiatives described in the literature; and examples of possible applications of synthetic biology for global health that are currently being developed.     

The Intersection of Independent Lies: Increasing Realism in Ecological Risk Assessment

In 1966, Levins presented a philosophical discussion on making inference about populations using clusters of models. In this article we provide an overview of model inference in ecological risk assessment, discuss the benefits and trade-offs of increasing model realism, show the similarities and differences between Levins' model clusters and those used in ecological risk assessment, and present how risk assessment models can incorporate Levins' ideas of truth through independent lies. Two aspects of Levins' philosophy are directly relevant to risk assessment. First, confidence in our interpretation of risk is increased when multiple risk assessments yield similar qualitative results. Second, model clusters should be evaluated to determine if they maximize precision, generality, or realism or a mix of the three. In the later case, the evaluation of each model will differ depending on whether it is more general, precise, or realistic relative to the other models used. We conclude that risk assessments can be strengthened using Levins' idea, but that Levins' caution that model outcome should not be mistaken for truth is still applicable.