医疗风险分担制度建设

本文重点对医疗风险分担现状与问题进行分析研究,在此基础上,利用损失分散、损失减少和损失承受原则进行了经济学分析,提出了加强医疗风险分担制度建设必须理论联系实际,通过树立对医疗风险的正确认识,依靠制度、法律和政策层面对医疗风险进行科学的、合理地、及时分散,以实现化解医疗纠纷、维护医疗秩序和促进医学事业健康发展的目的。     

我国医疗风险分担机制的探索与展望

医疗风险的发生具有无选择性、不确定性、客观性、普遍性,再加上医疗风险预警机制的缺陷、医患比失调、医患关系紧张等多方面因素导致医疗风险的发生不可避免。医疗风险转移和分担的方式早已受到全世界医学界的重视,在我国还处于刚刚起步阶段。本研究从国际上医疗风险分担机制具有的特点着手,并对我国现有的医疗风险分担形式分析,试图探索出符合我国国情更多形式的医疗风险承担方式。     

医疗资源紧张性医疗风险管理及对策探讨

在目前的医疗生态环境下,三级医院产科、新生儿科医疗资源紧张性医疗风险的问题日益凸显.构建一整套紧密联系、相互配合的医疗资源紧张性医疗风险防范和化解制度体系,具有很强的紧迫性和现实意义.文章通过医院实际工作情况的体会,探索产科、新生儿科资源紧张性医疗风险的管理对策.     

设立职工工作风险资金 建立医疗风险分担机制

1新形势下我国医院医疗风险管理面临的问题1．1医疗风险与承担主体之间的矛盾目前在医疗风险的管理上．我国没有形成明确的政府、社会团体、医院、医务人员和患者共同分担医疗风险的科学合理的管理体制和运行机制．在医疗风险的管理上存在着政府缺位、法律保障无力、机制体制不健全、患者过度维权、医院被动、医务人员无奈的情况。     

透视我国医疗风险的特点、种类及成因

对于医疗行业所面临的日益严峻的风险问题，我国目前尚未形成有效的化解机制，这不仅影响了医疗队伍的稳定性，也给医学事业的发展带来严重的隐患。为进一步认识医疗风险，建立与之相匹配的防范和管理体系，从医疗风险的特点、种类及成因三方面时我国医疗风险的现状进行分析。     

利益相关主体医疗风险分担机制的探讨

随着科技的快速发展和信息的扁平化，人类社会的各种风险在不断扩大，个体承担风险的程度是有限的，利益相关主体的合理化分担是保证风险化解的基础。医学作为一门不精确的科学，接近真理和无法穷尽真理是客观事实，作为探索医学真理的利益相关主体的患者、医疗工作者、医院和政府，单一分担医疗风险是不合理的，只有按照相关的规则共同分担，才能保证医学科学的进步和发展。     

医疗服务供方分担医疗费用风险的探讨

医疗保险制度有效运作的关键是实施适宜的医疗费用控制策略。本文研究分析管理式医疗的特征及应用效益,探讨将管理式医疗的基本原理引入我国职工医疗保险制度,加强医疗服务供方分担医疗费用增长风险的责任。改革支付方式,强化对供方的制约机制;规范医疗服务提供者的医疗行为;对特定人群疾病的疾病管理(Disease Manage-ment）应用;加强医疗保险立法建设;合理控制医疗费用增长,为人民群众提供优质、收费合理的服务。     

医疗风险及其处理方式的探讨

探讨医疗风险处理的目的在于提高医疗风险防范意识，建立合理的医疗风险分担与医疗争议赔偿社会化机制。医疗风险是客观存在的，它具有兼容性、复杂性、危害性等特点。引发医疗风险的因素也是复杂的，常见的有医疗主体因素、医疗客体因素、疾病因素、医疗仪器设备因素等。财务处理两大类。目前，对医疗风险进行保险已势在必行。我们应建立四位一体的医疗风险保险形式，佘正、公平、客观、科学地处理医疗争议，防范医疗风险。     

医疗风险预警和防控机制的研究进展

近年来，国内外不少学者先后就建立医疗风险预警和防范机制做出了积极探讨。我们通过对近几年有关研究文献的复习，就此作一综述。     

日本医疗风险监管体系评价

目的评价日本医疗风险防范管理体系及对建立我国医疗风险监测预警机制的借鉴意义。方法检索国内外相关数据库、官方网站，如WHO、日本卫生保健质量委员会和健康、劳动和福利部等，全面收集有关日本医疗风险管理、医疗差错和病人安全等方面文献，将文献分类分级统计并进行描述性研究。结果日本由健康、福利和劳动部全权负责卫生保健质量提高工作，通过成立卫生保健质量委员会，牵头定期举办病人安全研讨会，建立报告系统，促进形成安全的医疗环境，在卫生保健领域使用计算机系统等措施以防范医疗风险，并取得了一定的成绩。结论日本政府在防范医疗风险、确保病人安全方面所采取的措施，对建立符合我国国情的医疗风险防范和管理体系具有重要的借鉴意义和参考价值。     

Improving professional competence--the way ahead?

Globally, there has been considerable interest from the public, medical profession, and governments in ensuring that doctors are fit for practice. Appropriate accountability for the profession has become an important contemporary issue. With doubts emerging on the effectiveness of professionally led regulation, a variety of different mechanisms have been devised to ensure that patients receive appropriate and good quality care. This paper reviews regulation of the medical profession and indicates the way in which doctors in the UK are held accountable for their practice.     

论政府在纠正医疗市场缺陷中的作用

医疗行业是一个存在着市场竞争缺陷的领域,政府的干预对其良好运作是不可或缺的。政府应该允许不同的提供系统在供给方面展开竞争、设立守门人的制度、建立第三方购买者的监督机制、提供公共卫生服务、满足社会弱势群体的基本医疗需要。     

Hospital consultations and jurisdiction over patients: consequences for the medical profession

Advances in biomedical technologies and the increased specialisation of the medical profession have made collaborations among specialty physicians integral to care delivery. As physicians increasingly must share patients, how does this shape the jurisdiction that physicians hold? The sociological literature has extensively documented inter‐professional jurisdictional claims and conflicts to maintain the professional power of physicians in relation to allied occupational groups. However, less is known of intra‐professional avoidance and resolution of conflict over jurisdiction. This case study considers how jurisdictions are shared, maintained and challenged in a single profession. Drawing from ethnographic and interview data collected from September 2010 to October 2012 on the internal medicine service of a teaching hospital in the USA, I demonstrate the variation in jurisdictional conflicts that emerge between internal medicine and other specialties during the consultation process. Ignoring shared jurisdictions and refusing to accept jurisdiction of patients generate disputes among the principal medical and specialist teams. These disputes ensue due to blurred boundaries dividing the various specialties. To avoid conflicts, internal medicine physicians adopt strategies behind the scenes to facilitate smooth consultations.     

道德价值认同与医学人文教育

医疗既是高技术、高风险、高责任的职业,也是高情感、高奉献的工作。在医疗服务工作中,将道德价值认同纳入医学人文教育之中,正确处理医学人文精神与医学科学精神,发扬医学人文精神,实现医学与人文的融合具有十分重要的现实意义。     

制约医学院校非医学专业本科毕业论文质量提高的因素分析

[目的]文章从学生、教师、管理三个方面阐述了制约医学院校非医学专业本科毕业论丈质量提高的原因,提出符合医学院校特点和规律的本科毕业论文质量监控建议。[方法]采用整群抽样的方法抽取四所医学院中部分非医学专业865名2007级毕业生进行问卷调查,并对部分人员进行深入访谈。[结果]学生主动学习的积极性不高、指导教师指导人数过多且经验丰富的教师缺乏、毕业论文质量监控体系尚不完善是制约医学院校非医学专业本科毕业论文质量提高的三大因素。[结论]结合学生是毕业论文撰写的主体、教师是向导、管理是关键的观点,从三个方面加强工作,促进医学院校非医学专业本科毕业论文质量的提高。     

卫生人才流失的风险防范

人才流失已成为卫生人才发展的一个战略性话题，医院管理水平的高低可以直接反映在人才的流失率上。当今卫生行业的竞争就是人才的竞争，没有人才谈何发展。本文立足于卫生行业，对卫生行业人才流失的原因进行分析探讨，以期引起医院管理者广泛重视，做好人才流失的防范工作。     

医疗行业竞争特点、投资障碍和应对策略

本文从投资的角度分析了医疗行业的竞争特点，阐述了医疗行业已经形成的政策壁垒、资金壁垒及预期反击和尚未形成的成本壁垒或歧异壁垒。由此，提出了医疗机构可以采取的三种竞争战略：成本领先战略，标歧立异战略和目标集聚战略。     

Doctors on the medical profession

Over the past two to three decades there has been vigorous debate in the sociological literature as well as in popular forums concerning the changing social position and status of the medical profession and the extent to which consumerism has entered the doctor-patient relationship. Few qualitative sociological inquiries, however, have directly sought the views of medical practitioners themselves on these issues. To address this hiatus, this article discusses the findings from an empirical study using semi-structured indepth interviews with 20 doctors living and working in Sydney about their views on the contemporary status of the medical profession and their experiences of medical practice. Three major aspects are discussed: the extent to which the social position of doctors has changed, the impact of consumerism on medical practice and the qualities of a ‘good’ doctor. The implications of these data for theorising the nature of contemporary medical practice, power and professional status is explored, with particular reference to the insights offered by Foucauldian theory.     

Professional autonomy and surveillance: the case of public reporting in cardiac surgery

Professional autonomy has come under greater scrutiny due to managerialism, consumerism, information and communication technologies (ICT), and the changing composition of professions themselves. This scrutiny is often portrayed as a tension between professional and managerial logics. Recently, medical autonomy has increasingly been shaped in terms of transparency, where publication of clinical performance (via ICT) might be a more pervasive form of surveillance. Such transparency may have the potential for a more explicit managerial logic but is contested by clinicians. This paper applies notions of surveillance to public reporting of cardiac surgery, involving the online publication of mortality rates of named surgeons. It draws on qualitative data from a case‐study of cardiac surgeons in one hospital, incorporating interviews with health care managers and national policymakers in England. We examine how managerial logics are mediated by professional autonomy, generating patterns of enrolment, resistance and reactivity to public reporting. The managerial ‘gaze' of public reporting is becoming widespread but the surgical specialty is accommodating it, leading to a re‐assertion of knowledge, based on professional definitions. The paper assesses whether this form of surveillance is challenging to or being assimilated by the medical profession, thereby recasting the profession itself.     

发达国家和地区医疗风险管理的措施及借鉴意义

目的　研究发达国家和地区医疗风险管理的措施及其对医疗行业的借鉴意义。方法　我们搜集相关医疗风险管理资料供研究及分析。结果 发达国家和地区在电子记录、质量反馈系统和病人安全监测系统方面取得了很大进步,减少了医疗差错及医疗风险;同时,也强调信息收集与信息报告制度,特别注重医疗风险分析及管理以保障公共健康。结论 发达国家和地区在医疗风险管理方面取得了显著成绩, 对我国建立医疗风险监测和管理机制具有借鉴意义。