浅谈医疗集团的强强联合

90年代末,我国城市医疗集团发展势头强劲,以大型医院为龙头的医疗集团仅北京就出现8家.医疗集团的出现并不是我国医疗领域的特殊和独立的现象,在美国,仅1995年就有20%的医院涉及了合并与出售.在英国,医院集团的组建是在集内部进行资源重组.从国内经济改革的背景看,构建象"首都联合医疗集团"这种强强联合的决策者是出于怎样的考虑呢?我们是否可以按照如下的思路进行分析.     

华西医科大学附属第一医院院长石应康谈大型医院经济管理改革

目前，国有大型医院与国营企业一样，存在着外部环境和内部环境管理的诸多问题。国家主管部门应注意宏观政策的制定与导向，完善法制建设，改善医院外部环境。医疗单位则应改变观念，抓住机遇，加强内涵建设，实行有远见的内部全方位改革。提倡与鼓励正确处理社会效益和经济效益关系导向下的改革，探索新的历史时期医院管理改革的新模式。我认为，大型医院管理改革的切入点应是医院人、财、物的管理，其中经济管理是核心。经济管理应以建立社会效益为首位，挖掘国有资产潜力，提高劳动效率，增加经济收入，建章堵漏，实行全成本核算，合理节…     

关于常州市区域卫生规划中组建医院管理集团的思考

根据医院面临的改革形势、国内外医院管理模式发展趋势 ,分析常州市医院面临的竞争压力和潜在优势。我们提出建立医院管理集团的基本设想 ,并探讨建立常州市医院管理集团的目标、利弊、原则和前提条件。一、医院现存问题当前医院面临的主要改革压力表现为 3个方面 :一是医疗卫生系统的机构改革压力 ,表现为潜在的关停并转要求。这一改革要求对于大型医院来说 ,短期内是非刚性的 ,但提示了一种发展方向。二是医疗机构内部改革的压力 ,表现为医药分开、减员增效、财会改革以及分配制度等 ,其中后勤社会化为减员增效措施之一。三是医疗机构相互…     

完善医院集团内部控制提高财务管理水平

随着我国医疗卫生事业改革的发展，医院重组不断进行，医院集团得到了迅速发展。由于医院集团是一种新生事物，会计基础在医院集团的基础薄弱，财务管理在医院集团可以借鉴的经验少，成熟的理论与措施又不够完善，如何在新的形势下，加强医院集团内部控制，发挥财务管理的职能已经成为影响医院集团发展的阻力之一。笔者认为医院集团应完善内部财务控制，提高财务管理的途径和方法可从以下几个方面着手：     

试论国有医院的良性发展与体制创新

国有医院从建国以来至今始终是我国医疗卫生事业的主体和中坚力量，也是国有资产的重要组成部分。随着我国经济体制改革的不断深入，我国的医疗卫生管理体制从宏观到微观也开始了全方位的改革，国有医院发展所面临的外部和内部环境都发生了深刻的变化。在新形势下，如何通过改善国有医院运行的外部环境，改革内部管理制度，使国有医院适应形势发展的需要，实现良性、快速发展，对于整个医疗卫生事业的发展和国有资产的保值增值都有着极为重要和深远的意义。１国有医院的发展环境面临着深刻的变化改革开放以来，随着我国市场经济体制的逐步建…     

靖江市组建医疗集团的实践与思考

靖江市积极探索国有卫生资产的多种实现形式和公立医院管办分开的改革,组建了医疗集团,管理市人民医院和中医院。集团运行近1年,完善内涵建设,推进运行机制改革,两所医院实现了资源共享、优势互补、错位发展,医疗技术和服务水平不断提升,既实现了医院资产的保值增值,又满足了人民群众日益增长的医疗保健需求。     

试论国有医院改制进程中的内部监察机制

国有医院改制是国有医院改革的延续和发展，是建立医疗市场竞争机制的重要基础，是完善医疗卫生体系的重要举措。随着国有医院改制的不断深入，体制性、机制性等深层次的矛盾和问题逐步显现，必须在国有医院改制进程中建立健全并强化医院内部监察制约机制，以保证国有资产的保值与增值，从改制这个源头上纠正和治理行业不正之风，维护国家和人民群众的根本利益。     

现阶段国有医院产权改革初始条件的分析

在当前国有医院产权改革产生较大争论的背景下,从产权改革的制度条件、社会保障、城乡协调发展、就业等宏观经济背景与国有医院的关系,分析了国有医院产权改革初始条件,提出了当前国有医院产权改革必须与宏观经济体制与环境相适应.     

辽宁:探索医院集团化改革模式

<正>如何释放和下沉大医院优质医疗资源,激活并带动基层医疗卫生机构发展,在基层解决患者基本医疗需求,辽宁省卫生计生委探索以医院集团化改革,加速建立分级诊疗的新秩序。2014年已经初见成效。2013年,辽宁省两家医院集团组建——中国医科大学附属盛京医院医院集团和中国医科大学附属第一医院医院集团,主体医院均为省内大型公立医院的领头羊。集团化改革的目标,就是发挥龙头三甲医院在人才、技术、管理等     

社会资本进入国有医院装备领域的形式及利弊分析

目前,许多医院在高速发展中遇到了资金瓶颈问题,特别是在采购大型设备等资金量大的领域,仅靠银行贷款和自有资金积累是远远不够的,这为社会资本进入国有医院打开了一扇窗户,使国有医院和社会资本的结合找到了一条捷径.本文仅就社会资本进入国有医院装备领域的形式及利弊进行分析.     

大型公立医院对中小型医院帮带的路径选择——托管模式下医院文化融合的探索与实践

大型公立医院对中小型医院的托管,是前者履行社会职能对中小医院实施帮带的重要途径之一,其本质是跨文化医院间各种资源的深度整合,故解决两所医院间的文化冲突蕴含于整个托管过程。笔者在对广州市某大型公立医院托管企业医院的案例进行研究后发现,在对两所医院托管前的文化建设现状进行深度识别的基础上,采取"文化融合"的方式可以较好地处理两者之间的文化冲突,有效提升托管成效,同时还对托管过程中解决文化冲突要重点关注的因素进行了探讨。     

数字化医院建设进程中的财务精细化管理研究

新医改方案明确提出,医院要以医院管理和电子病历为重点,推进信息化建设。目前,大型医院开展了数字化医院建设的实践,依托医院资源规则(HRP),创新运营管理手段,打造精细化的财务管理平台。笔者对大型医院在数字化医院建设过程中的相关财务问题进行了简要地分析。     

试论医院人文管理与文化创设

现代医院管理应当顺应管理科学发展趋势，坚持以人为本，重视开发和利用医院的人文资源，实行更符合人的特点和人性要求的人文管理。在人文管理中必须依据文化理念，实现医院管理活动中内在的协调与和谐。要在把握医院人文管理内在要求的基础上进行医院文化的创新，努力构建发展战略支持型的医院文化。     

Variation in Hospital Length of Stay: Do Physicians Adapt Their Length of Stay Decisions to What Is Usual in the Hospital Where They Work?

OBJECTIVE: To test the hypothesis that physicians who work in different hospitals adapt their length of stay decisions to what is usual in the hospital under consideration. DATA SOURCES: Secondary data were used, originating from the Statewide Planning and Research Cooperative System (SPARCS). SPARCS is a major management tool for assisting hospitals, agencies, and health care organizations with decision making in relation to financial planning and monitoring of inpatient and ambulatory surgery services and costs in New York state. STUDY DESIGN: Data on length of stay for surgical interventions and medical conditions (a total of seven diagnosis-related groups [DRGs]) were studied, to find out whether there is more variation between than within hospitals. Data (1999, 2000, and 2001) from all hospitals in New York state were used. The study examined physicians practicing in one hospital and physicians practicing in more than one hospital, to determine whether average length of stay differs according to the hospital of practice. Multilevel models were used to determine variation between and within hospitals. A t-test was used to test whether length of stay for patients of each multihospital physician differed from the average length of stay in each of the two hospitals. PRINCIPAL FINDINGS: There is significantly (p<.05) more variation between than within hospitals in most of the study populations. Physicians working in two hospitals had patient lengths of stay comparable with the usual practice in the hospital where the procedure was performed. The proportion of physicians working in one hospital did not have a consistent effect for all DRGs on the variation within hospitals. CONCLUSION: Physicians adapt to their colleagues or to the managerial demands of the particular hospital in which they work. The hospital and broader work environment should be taken into account when developing effective interventions to reduce variation in medical practice.     

The use of state and general hospitals for inpatient psychiatric care.

OBJECTIVES: This paper explores the relationship of state hospital and general hospital psychiatric caseloads in a statewide system of care. METHODS: Probabilistic population estimation was applied to general hospital and state hospital data sets. RESULTS: General hospitals provide inpatient psychiatric services to more people than do state hospitals, and a significant number are served in both sectors. There were notable differences in use patterns related to patient gender and age. CONCLUSIONS: These results demonstrate that probabilistic methodologies can significantly enhance the value of existing databases for epidemiological research.     

新医改对大型公立医院的影响及对策研究

大型公立医院作为卫生系统的排头兵,新医改实施方案对大型公立医院的影响可谓首当其冲。本文从分析新医改对大型公立医院将会产生的影响入手,指出大型公立医院应抓住时机,利用自身的优势,调整医院的发展策略,重新对医院进行定位,迎接新医改实施方案对医院带来的挑战。     

The interdependence of mental health service systems: the effects of VA mental health funding on veterans' use of state mental health inpatient facilities

BACKGROUND: There are relatively few published data on how the financial structures of different health systems affect each other. With increasing financial restrictions in both public and private healthcare systems, it is important to understand how changes in one system (e.g. VA mental healthcare) affect utilization of other systems (e.g. state hospitals). AIMS OF THE STUDY: This study utilizes data from state hospitals in eight states to examine the relationship of VA per capita mental health funding and state per capita mental health expenditures to veterans' use of state hospitals, adjusting for other determinants of utilization. METHODS: This study utilized a large database that included records from all male inpatient admissions to state hospitals between 1984 and 1989 in eight states (n = 152541). Funding levels for state hospitals and VA mental health systems were examined as alternative enabling factors for veterans' use of state hospital care. Logistic regression models were adjusted for other determinants of utilization such as socio-economic status, diagnosis, travel distances to VA and non-VA facilities and the proportion of veterans in the population. RESULTS: The single strongest predictor of whether a state hospital patient would be a veteran was the level of VA mental healthcare funding (OR = 0.81 per $10 of funding per veteran in the population, p = 0.0001), with higher VA funding associated with less use of state hospitals by veterans. Higher per capita state funding, reciprocally, increased veterans' use of state hospitals. We also calculated elasticities for state hospital use with respect to VA mental healthcare funding and with respect to state hospital per capita funding. A 50% increase in VA per capita mental health spending was associated with a 30% decrease in veterans' use of state hospitals (elasticity of -0.6). Conversely, a 50% increase in state hospital per capita funding was associated with only an 11% increase in veterans' use of state hospitals (elasticity of 0.06). IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: These data indicate that per capita funding for state hospitals and VA mental health systems exerts a significant influence on service use, apparently mediated by the effect on supply of mental health services. Veterans are likely to substitute state hospital care for VA care when funding restrictions limit the availability of VA mental health services. However, due to the relative sizes of the two systems, VA funding has a larger effect than state hospital funding upon state hospital use by veterans. IMPLICATIONS FOR HEALTH POLICIES: These data indicate that changes in the organizational and/or financial structure of any given healthcare system have the potential to affect surrounding systems, possibly quite substantially. Policy makers should take this into account when making decisions, instead of approaching systems as independent, as has been traditional. IMPLICATIONS FOR FURTHER RESEARCH: Further research is needed in two areas. First, these results should be replicated in other systems of care using more recent data. Second, these results are difficult to generalize to individual behavior. Future research should examine the extent and individual determinants of cross-system use.     

基于SE-SBM模型的贵州省三级医院电子病历系统建设效率评价

目的对贵州省2019年三级医院电子病历系统建设效率进行评价,为提高医院信息化水平提供参考。方法以贵州省58家三级医院为研究对象,采用超效率DEA模型（SE-SBM模型）,从投入指标、产出指标两方面,测算电子病历系统建设综合技术效率、纯技术效率和规模效率。结果58家医院中,5家医院处于DEA有效状态,53家医院处于非DEA有效状态。医院信息部门人员未出现冗余,但21家医院存在不同程度的信息化投入冗余。16家医院电子病历系统级别产出不足,29家医院电子病历系统评分产出不足。结论贵州省三级医院电子病历系统建设普遍存在产出不足情况,整体效率有待进一步提高。医院应更加重视电子病历系统建设,加强精细化管理,提高资源利用效率。     

240家大型公立医院院训特点分析

医院精神是医院文化的内核，表现在文字层面就是医院的院训，是医院员工核心价值观的集中体现。笔者调查分析了国内240家三甲医院，发现当代医院院训构成显现出追求对偶整饬、词约义丰、音韵和谐的美感，以及对儒家仁爱诚信思想的继承等特点，但也存在政治化倾向、缺乏独创性、亲和力和服务意识等问题。医院精神的凝炼应当走下圣坛，绕开政治化、功利化、趋同化的漩涡，努力实现个性化发展及与患方的和谐交融。