深化上海市职工医疗保障制度改革的主要措施和步骤

介绍上海市职工医疗保障制度改革在实行医疗保险费用社会统筹、建立个人医疗帐户、完善老年医疗保障制度、调整企业医疗机构、推动多层次的医疗保障等方面的措施以及坚持由国家、单位和个人合理分担医疗费用,增加个人自我保障责任;实行社会化管理;理顺医院经营机制,提高医院服务质量的改革步骤。     

军队医院如何做好医疗保障制度改革工作

军队医疗制度改革是适应国家医疗保障制度改革的客观需要。做好军队医院医疗保障制度改革是做好军队卫勤保障的关键,本文结合单位工作实际,简述了军队医疗保障制度改革应把握的几个重要问题。     

江苏医疗保障制度改革试点城市医院改革的调查与思考

医疗保障制度改革对医院产生了四个方面的影响：医院业务收入增长幅度明显下降;医院工作效率有所提高;医院服务结构有了变化;医院服务行为进一步规范。医疗保障制度改革必须地带动了医院内部改革向前发展：一是更新了思想观念;二是强化了经营管理;三是优化了内部资源配置;四是提高了工作效率;五是改进了医疗服务。由于国家改革政策不配套,当前医院改革面诸多困难和问题,如政府财政投入不足,医疗服务价格体系不合理,影响医     

谈医疗保障制度改革中的思想工作

伴随我国全面推行医疗保障制度改革,医院也成为了医疗机构改革的主体和主角,关系着医疗保障制度改革的成败。在这种形势下,医院思想工作要积极主动进入角色,围绕如何使广大职工的思想观念适应新形势提供强有力的思想保证和理论支持工作,提出相应的对策,从而促使医院全体职工积极参与改革。我认为,在当前医疗保障制度的改革中,医院思想工作要突出做好３项工作。 一是树立全局观念,增强群众观点．统一思想认识,积极倡导有利于推进医院改革的新思想、新观念。必须与城镇职工基本医疗保障制度改革同步进行的医疗机构改革,同样是一项…     

对医院适应国家医疗保障制度改革的思考

随着社会主义经济的确立和完善，建立医疗保障制度，已成为我国卫生事业改革发展的趋势。医疗保障制度的实施，将直接或间接地影响医院传统的建设思路。因此，医院如何适应医疗保障制度改革，已成为医院管理者关注的焦点。一、提高认识，更新观念医疗保障制度改革是一项大变革，政策性强、涉及面广、难度大。医院管理者对目前面临的形势和问题，一方面要加强宣传教育，使广大医务人员充分认识医疗保障制度改革的意义、目的和要求，调动他们支持改革、参与改革的自觉性和积极性；另一方面要解放思想，转变观念，参与竞争，主动适应经济增长方…     

军队医疗保障制度改革应正确处理三个关系

随着国家医疗保障制度改革的逐步展开,军队医疗保障制度改革也势在必行，我军现行的医疗保障制度几十年无根本变动，已难以适应国家和军队现代化建设的要求，军队自身医疗保障与地方医疗制度改革不相适应，笔从医院管理和防治体系实际情况，认为军队医疗保障制度改革应着重处理好三个关系。     

论当前企业医院内部改革的难点与出路

“两江”医疗保障制度改革的经验,推动了全国医疗保障制度改革的迅猛发展。企业医院应主动适应市场经济的大环境、大趋势,深化内部改革。认为应从 4个方面入手解决企业医院实行内部改革的难点:1.立即着手准备进行全面及经济核算;2.改变过度的集权式管理,在内部划小核算单位,设立模拟法人责任制,分块放权搞活;3.建立与市场经济要求相适应的内部组织机构;4.实行分配制度、考评制度改革。     

军队医院参与地方医疗保障制度改革一年回顾

军队医院参与地方医疗保障制度改革一年回顾靳定安茅建华姚雪芹作者单位：２１２００１镇江市，解放军第三五九医院经国务院批准，１９９５年１月１日始，首先在镇江市和九江市进行医疗保障制度改革试点。我院作为全国第一批医疗保障制度改革试点城市镇江地区的一所军队医...     

军队医院适应医疗保险定点的做法

1998年,国务院作出了<关于建立城镇职工基本医疗保险制度的决定>(简称<医保>),要求在全国城镇职工中推行医疗保障制度改革,实行基本医疗保障制度.我院于2000年10月,被乐山市定为城镇职工基本医疗保险的首批定点医院,军队医院怎样适应国家医疗保障制度改革,已成为医院管理者关注的焦点,现就此谈谈看法.     

医院应主动适应医疗保障制度的改革

尽管国际上有些学者评价我国的医疗保障体系为最高效的，即花钱最少受益面最大的医疗保障体系。但我国医疗保障制度的改革事实上仍必须以压缩医疗费用的增涨为实质内容。医疗机问是医疗行为的执行者，其生存与发展依赖医疗收益或基本上依赖医疗收益支持。医疗保障制度的改革对医院的生存和发展是一个严峻的挑战。作为医院实在应该审时度势，不断改进自己的管理体制和运作机制来主动适应医疗保障制度的改革，谋求自己的生存和发展。1提高医疗质量是医疗保障制度改革的目标之一医院以医疗服务为主业，即如医科大学之附属医院有许多教学、科研…     

Users of home‐care services in a Nordic welfare state under marketisation: the rich,the poor and the sick

Stricter access to public services, outsourcing of municipal services and increasing allocation of public funding for the purchase of private services have resulted in a marketisation wave in Finland. In this context of a Nordic welfare state undergoing marketisation, this paper aims to examine the use of Finnish care services among older people and find out who are using these new kinds of private services. How wide is their use and do the users of private care services differ from those who are using public services? How usual is it to mix both public and private care services? The questionnaire survey data set used here was gathered in 2010 among the population aged 75 and over in the cities of Jyväskylä and Tampere (N = 1436). The methods of analysis used include cross‐tabulation, chi‐square tests and multinomial logistic regression. The findings showed that among those respondents who used care services (n = 681), 50% used only public services, 24% utilised solely private services and the remaining 26% used both kinds of services. Users of solely private services had significantly higher income and education as well as better health than those using public services only. The users of public services had the lowest education and income levels and usually lived in rented housing. The third group, those mixing both public and private services, reported poorer health than others. The results increase concerns about the development towards a two‐tier service system, jeopardising universalistic Nordic principles, and also suggest that older people with the highest needs do not receive adequate services without complementing their public provisions with private services.     

A comparative analysis of remuneration models for pharmaceutical professional services

ObjectivesPharmacists provide a wide range of professional services to support the appropriate use of medicines by patients. This study aims to conduct an international, comparative analysis of remuneration models for pharmaceutical professional services.MethodsInformation about remuneration models was derived from a literature review and a semi-structured questionnaire completed by experts.ResultsRemuneration models differ in the way that pharmacists are paid for professional services beyond dispensing medicines. Also, the scope of services that are remunerated varies. The majority of countries regulate remuneration for services only when the medicine is paid for under the reimbursement scheme. Remuneration of services implies a commitment to assure their quality in some countries. Collaborative practice models have been set up where pharmacists work together with other health care professionals to deliver diagnosis-specific services or services based on the patient's use of medicines. The remuneration of services is influenced by the value of services, budgetary constraints, the payer perspective, and the attitude of physicians, pharmacists and patients.ConclusionsProfessional organisations need to formulate a clear strategy for developing and gaining remuneration for pharmaceutical professional services. This implies that pharmacists not only demonstrate the value of services, but also assure their quality.     

The Nature of Physician's Services

A specific system for classifying services is applied to physicians' services in an attempt to better understand those services. Other services organizations are identified that are similar to these services along each of the dimensions suggested by the classification system. In addition, marketing insights and implications are offered for marketing physicians' services.     

Variation in types of service use and expenditures for individuals with developmental disabilities

BackgroundThis study examined the types of services and expenditures for 8 service categories provided by regional centers to 138,336 individuals with developmental disabilities living at home and in the community in California in 2004-2005.MethodsLogistic regressions of secondary data were used to predict the types of services received, and ordinary least squares regressions were used to predict types of service expenditures.ResultsHigher client needs generally were associated with higher odds of receiving services and with expenditures, although the types of services varied by client need. Controlling for client needs and other factors, males were more likely to receive out-of-home services. Individuals aged 3-21 years were generally less likely to receive many services but were more likely to receive in-home and out-of-home respite services than were those over age 62. All racial and ethnic minority groups were less likely to receive support and out-of-home services than were whites and had lower expenditures, although these varied by the types of services. The supply of nursing homes, community care facilities, area population characteristics, and regional centers also predicted variations in service use and expenditure patterns.ConclusionStudies of the underlying reasons for the variations are needed to ensure equity in access to all types of services and expenditures.     

社区基本预防服务界定及其成本测算研究

通过对社区预防服务的需要与提供、居民认知情况、需求意向与有偿服务需求以及社区基本预防服务项目的界定及其成本测算研究，提出了确立政府投入为主、多元化筹措的预防服务筹资模式，切实保障社区基本预防服务；讲求服务质量，提高预防服务效率，建立科学化管理程序；以需要为导向确定社区基本预防服务项目，结合需求提供有偿预防服务的建议。     

Geographical access to termination of pregnancy services in New Zealand

Background: The New Zealand government has made a commitment to reducing inequalities in health among its population through the New Zealand Health Strategy. Termination of Pregnancy (TOP) services are an important part of women's health services, and equity in access to services must be ensured. Objective: Assess geographic accessibility to first trimester termination of pregnancy services in New Zealand, and discuss implications for equity in access to services. Methods: TOP service information was obtained nationwide through online resources, and approximate driving distances between all major centres and the closest TOP service to which patients are referred to were calculated for each region. Census data and Statistics NZ data are used to compare population characteristics between regions with reduced geographic accessibility of TOP services. Results: Women who live in regions that do not offer local TOP services must travel on average 221km to access TOP services. This equates to an average return‐trip distance of 442km. Three of the five regions that do not have local TOP services available have a higher than average proportion of Maori population. Conclusions: The results of this study demonstrate that first‐trimester TOP services are relatively difficult to access for over one‐sixth of the women in New Zealand.     

Consumer Perceptions of Integrated Trauma-Informed Services Among Women with Co-Occurring Disorders

As part of a national, multi-site treatment outcome study, an instrument was designed to assess consumers’ perceptions of key services integrating trauma, mental health, and substance abuse issues, the Consumer Perceptions of Care (CPC). This study evaluates the psychometric properties of this instrument and analyzes consumers’ perceptions of the services they received. The results suggest that the measure has four factors: services integration, choice in services, trauma-informed assessment, and respect for cultural identity. These factors demonstrated adequate reliability, and the overall results suggested that the measure is a reliable, sensitive, and valid reflection of consumers’ perceptions of their services and their providers for diverse racial and ethnic groups. Women in the intervention programs perceived their services as more highly integrated for trauma, mental health, and substance use than women in the services as usual or comparison programs, supporting its utility as a measure of programs designed to provide integrated services.     

Benchmarking clinical photography services in the NHS

Benchmarking is used in services across the National Health Service (NHS) using various benchmarking programs. Clinical photography services do not have a program in place and services have to rely on ad hoc surveys of other services. A trial benchmarking exercise was undertaken with 13 services in NHS Trusts. This highlights valuable data and comparisons that can be used to benchmark and improve services throughout the profession.     

我国家庭医生签约服务利用现状及影响因素分析——基于全国31个省市的调查

目的：分析我国家庭医生签约服务利用现状及其影响因素。方法：对我国31个省（自治区、直辖市）的社区居民进行问卷调查,运用SPSS 25.0统计软件进行数据分析,采用Logistic回归模型探讨家庭医生签约服务利用现状的影响因素。结果及结论：居民对家庭医生签约服务的利用率偏低,不同特征人群利用签约服务的水平有差异。年龄、性别、户籍、文化程度、经济状况、卫生服务可及性是影响居民利用签约服务的重要因素;家庭医生签约服务利用情况的影响因素存在城乡差异,城市居民的签约服务利用情况更易受到地区因素的影响,而农村居民的签约服务利用情况更易受就业因素的影响。建议各地结合自身情况,完善家庭医生签约服务的政策设计,改善基层医疗卫生服务可及性,重点关注低收入人群和流动人口的签约服务,提高签约服务利用水平,推行有价值的家庭医生签约服务。     

Frequency and determinants of formal respite service use among caregivers of children with cerebral palsy in Ontario

OBJECTIVE: To describe the use of formal respite services among caregivers of children with cerebral palsy in Ontario and discuss the factors that may contribute to respite use and non-use. METHODS: A total of 468 caregivers were interviewed about their experience with formal respite services. Interviews were part of a larger cross-sectional study on caregiver health. Caregivers were asked about their knowledge of formal respite services; their use of formal respite services in the past year; financial implications relating to formal respite use; perceived barriers to formal respite service use; and reasons for not using formal respite services (if applicable). RESULTS: Nearly half (46%) of caregivers in the sample reported using respite services in the past year. Most of the caregivers who used respite services used more than one source of respite, had services provided in their home, often for less than 1 day, and reported using them more than six times. The most commonly cited reason for using formal respite services was for a planned break. Many factors influenced caregivers' use of formal respite services. Caregivers who had a child with a lower level of function, with multiple additional conditions, or who was male, were more likely to use formal respite services. Although over 90% of caregivers indicated that respite use is beneficial for both their family and child, over 60% reported facing many barriers while attempting to access respite services. CONCLUSION: Results from this cross-sectional study indicate that caregivers who used respite services used them frequently for breaks from caregiving. Caregivers described facing many barriers while attempting to access respite services therefore to improve caregiver's experience with respite services, strategies are suggested.