安徽大医院年内全部网上购药

安徽省卫生厅近日出台了《安徽省医疗机构网上药品集中招标采购工作实施方案》，提出力争到今年年底前，全省公立三级医院、省直医院全部实行药品网上集中招标采购；明年6月底前，全省公立二级以上医院将全部实行药品网上招标采购。     

药品集中招标采购工作存在的问题与建议

为了解和推进医疗机构药品集中招标采购工作 ,近期我们对泰州市医疗机构药品集中招标工作进行了调研 ,分析存在问题 ,并提出政策建议。一、工作目标按照纠风办和卫生行政部门的要求 ,２００２年泰州市药品招标采购工作的目标是 :１００%的医疗保险定点医院参加药品集中招标采购 ;纳入城镇职工基本医疗保险目录的药品原则上实行集中招标采购 ,其他临床应用普遍、采购量比较大的药品中 ,５０%的金额也应实行集中招标采购和集中议价采购 ;招标后形成的差价部分 ,在扣除医疗机构应得的药品差价收入后 ,让利于患者的比例不少于６０%。对照目标 ,…     

论药品集中招标采购的监督管理形式

药品集中招标采购,是指数家医疗机构联合组织的药品招标采购和共同委托招标代理机构组织的药品招标采购。城镇职工基本医疗保险(或公费医疗)药品目录中的药品、医疗机构临床使用量比较大的药品,原则上实行集中招标采购。大量使用的医用材料和大型医疗设备也可以延伸实行集中招标采购。     

对开展药品集中招标采购试点工作的思考

一、山东省药品集中招标采购工作的基本情况 山东省是试行药品集中招标采购工作较早的省份。早在1999年，济南、青岛等市就积极探索了药品集中招标采购工作。2000年，山东省按照国家的部署，坚持公开、公正、公平原则，积极开展了药品集中招标采购试点工作。     

药品集中招标采购操作过程中存在问题初探

对我国药品集中招标采购工作实施过程中存在的问题进行了分析，这些问题表现为招标主体五花八门，中介机构违规操作；招标品种选择不合理，评价标准不科学；招标过程不透明，存在暗箱操作；合同签订及执行不规范，不按规定履约；招标过程繁琐，加重了企业负担；缺乏成熟的集中招标采购运作模式等。从而为规范药品集中招标采购操作过程、确保其实施效果提供科学依据。     

句容市实施药品集中招标采购的做法与体会

自2000年起，江苏省句容市卫生局推行药品集中招标采购，三年多来，集中招标采购总金额达9184万元，药品平均降价幅度达25％，实现了药品集中招标覆盖面、临床用药招标采购量、药品供应商进入招标采购中心、药品收支实行专户管理四个100％的目标，取得了群众、药品供应商、医疗机构三方满意的良好效果。     

福建省药品招标采购存在的问题及对策

为了减少药品采购的中间环节，规范医院药品采购行为，降低药品虚高价格，减轻患者经济负担，福建省认真贯彻国务院办公厅《关于城镇医药卫生体制改革的指导意见》和国务院纠风办等六部委《医疗机构药品集中招标采购监督管理办法》，于2002年7月在全省统一开展了第一批药品集中招标采购，累计中标1280个规格、品种的抗菌类备选药品。经对四家医院的调查表明，实行药品集中招标后药品毛利额、毛利率及零售价均有所下降(见附表)，在一定程度上减轻了患者的负担。但由于实行集中招标采购药品的品种、剂型、规格、数量所占比例都比较小，药品集中招标采购在运作过程中还存在不够规范等问题，需要在实践中进一步探讨改进。     

医疗器械招标须注意的几个问题

医疗机构开展医疗器械集中招标采购，是在成功开展药品集中招标采购工作的基础上，为深化卫生改革、规范采购行为、建立新型的医疗器械采购模式、切实降低医疗成本、提高服务质量、最终惠及广大群众而推出的一项新举措。作为湖北省确定的医疗器械医用材料集中招标采购工作试点地市，根据荆州市药品集中招标采购指导委员会的部署，荆州市药品集中招标采购中心于2003年4—10月在长江大学医学院和市直医疗卫生机构组织了3次医疗器械招标采购。     

让医疗机构合理分享集中招标采购的好处

正确处理患者和医疗机构之间的利益关系．是药品集中招标采购政策的核心问题。现行政策反复强调合理分配集中招标采购的好处，要求把集中招标采购的好处大部分让利给患者，兼顾医疗机构招标采购的积极性。对医疗机构由于实行集中招标采购减少的药品收入，要通过调整医疗服务价格予以合理补偿。这一利益分配原则无疑是正确的，但医疗机构对具体政策措施并不满意。究其原因，是因为现行政策措施使医疗机构无法合理分享集中招标采购的好处。     

我国各省新一轮集中招标采购政策对比分析

目的:研究各省份新一轮药品集中招标采购政策,为完善各省份集中招标采购工作提供借鉴和参考。方法:检索收集《关于完善公立医院药品集中采购工作的指导意见》和《关于落实完善公立医院药品集中采购工作指导意见的通知》发布以来各省份出台的最新集中采购文件,运用文献分析法、对比分析法以及专家咨询法对其中的集中招标采购内容进行分析,归纳总结各省集中招标采购工作的差异。结果:各省份的工作进展不尽相同,在带量采购、限价规定、双信封评审等方面存在较大差异。结论:实行分层限价以体现药品质量差异,基于参考价的平均值确定限价范围,设置合理的经济技术指标,综合经济技术评分和价格确定中标药品,增加中标药品数量以保障药品供应。     

Me-too pharmaceuticals -- marketing-strategies of drug producers and drug purchasers. Example: non-ionic contrast media

In the context of increasing economic pressure upon on hospital budgets, it is inevitable that central and standardized purchasing of pharmaceuticals must be considered. It was the aim of this assessment to analyse the many different non-ionic contrast media/CM products on the actual "clinical relevance of the differences" in order to give advice for a more concerted purchasing of CM. The assessment was commissioned by a large scale Austrian hospital cooperation; it can be regarded as the beginning of a broad strategy against the many new, only rarely innovative, but nevertheless patent-protected pharmaceuticals. Eight different non-ionic contrast media - used in routine care - were compared for their physico-chemical characteristics: osmolality, nephrotoxicity, viscosity, hydrophilicity and electric charge. In a systematic review 193 publications were analysed. RESULT: The examined CM show similar pharmacokinetic and -dynamic attributes, and no differences of clinical relevance. An optimisation of purchasing pharmaceuticals by standardisation of the range of products takes place in the context of common strategies of producers and buying agents in marketing-economies. The strategies of the pharmaceutical industry (patent protection of me-too drugs, high-price-policy, extensive marketing of up to 40 % of revenue) and the counter-strategies of the central hospital purchasers (market concentration, drug commissions, institutional measures to disentangle interests) are presented - exemplified by contrast media - in this article.     

对医院物资采购管理的认识与探索

目的：加强物资采购管理实施的全过程,阐述物资是医院采购管理的基本要素之一。方法：介绍在物资采购改革中寻求适合医院建设与发展的采购管理模式,主要对临床需求量大、金额小的物资实行医院统一集中采购,取消各科室分散采购。结果：科学合理的物资采购管理能够给医疗机构带来一定的经济效益和社会效益。杜绝了同一物品价格不一、消耗量大、去向不明等现象,保证医疗工作正常运转,为医院节省了开支。结论：随着医疗卫生体制改革的不断深入,采购管理模式也在发生着巨大的变化,因此需要适应新的形势要求。     

High-risk proposition. With CMS' 'value-based purchasing' model, struggling hospitals are wondering if they can afford the IT needed to make it work

As the CMS pushes its "value-based purchasing" model, hospitals are left wondering if they'll get squeezed by a program that will require them to invest big bucks in technology. "People need to ... understand it is a way of transforming Medicare from a passive payer of claims to an active purchaser of higher-quality, more-efficient services," says the CMS' Thomas Valuck.     

Notes from the field: the economic value chain in disease management organizations.

The disease management (DM) "value chain" is composed of a linear series of steps that include operational milestones in the development of knowledge, each stage evolving from the preceding one. As an adaptation of Michael Porter's "value chain" model, the process flow in DM moves along the following path: (1) data/information technology, (2) information generation, (3) analysis, (4) assessment/recommendations, (5) actionable customer plan, and (6) program assessment/reassessment. Each of these stages is managed as a major line of product operations within a DM company or health plan. Metrics around each of the key production variables create benchmark milestones, ongoing management insight into program effectiveness, and potential drivers for activity-based cost accounting pricing models. The value chain process must remain robust from early entry of data and information into the system, through the final presentation and recommendations for our clients if the program is to be effective. For individuals involved in the evaluation or review of DM programs, this framework is an excellent method to visualize the key components and sequence in the process. The value chain model is an excellent way to establish the value of a formal DM program and to create a consultancy relationship with a client involved in purchasing these complex services.     

The quality of health purchasing

Much has been written about quality in patient care and clinical support services, but very little about the quality of purchasing. This paper gives an overview of quality issues in purchasing, and offers guidelines and practical steps for purchasers to improve service quality--both their own and their providers'. It defines quality in purchasing and considers how purchasers can influence markets and work with providers to improve health services quality. The paper gives practical guidance for improving quality, which recognises the limited resources and skills which purchasers have for the task. It addresses some issues raised by purchaser/managers: How does a purchasing organisation measure and improve quality? Is there a better way of specifying and monitoring quality than the "shopping-list of standards" approach--what should be asked of providers? How can information about clinical quality, outcome and costs, be obtained in a form in which reliable comparisons can be made? Is quality accreditation or registration a good predictor of future quality?     

Do pharmaceuticals displace local knowledge and use of medicinal plants? Estimates from a cross-sectional study in a rural indigenous community,Mexico

Researchers examining the relationships between traditional medicine and biomedicine have observed two conflicting tendencies. Some suggest that the use of biomedicine and biomedical concepts displaces the use of traditional medicine and medical beliefs. Other scholars have found that traditional medicine and biomedicine can co-exist, complement, and blend with each other. In this paper we use an econometric model and quantitative data to test the association between individual knowledge of pharmaceuticals and individual knowledge of medicinal plants. We use data from a survey among 136 household heads living in a rural indigenous community in Oaxaca, Mexico. Data were collected as a part of long term fieldwork conducted between April 2005 and August 2006 and between December 2006 and April 2007. We found a significant positive association between an individual's knowledge of medicinal plants and the same individual's knowledge of pharmaceuticals, as well as between her use of medicinal plants and her use of pharmaceuticals. We also found a negative association between the use of medicinal plants and schooling. Our results suggest that, in the study site, individual knowledge of medicinal plants and individual knowledge of pharmaceuticals co-exist in a way which might be interpreted as complementary. We conclude that social organization involved in the use of medicines from both traditional medicine and biomedicine is of particular significance, as our findings suggest that the use of pharmaceuticals alone is not associated with a decline in knowledge/use of medicinal plants.     

“健康扶贫”——西藏食品放射性污染风险监测及个人剂量监测调查与分析

为精准实施“健康扶贫”“脱贫攻坚”工作任务、完善对口扶贫工作机制、提高贫困地区疾控工作能力、使个人剂量监测与食品放射性污染风险监测工作达到全国覆盖,依据党中央、国务院脱贫攻坚决策部署,落实精准扶贫精准脱贫基本方略,中国疾病预防控制中心辐射防护与核安全医学所从2012年对西藏开展“健康扶贫”工作,针对西藏地区职业人员的个人剂量监测及食品放射性污染风险监测工作进行了重点指导和帮扶。截至2021年4月,共援助西藏自治区开展了13个季度的免费个人剂量监测、2次培训指导和1次现场教学等工作。在食品放射性污染风险监测方面连续5年为西藏自治区进行了3次现场培训指导、60份食品样品的放射性核素检测与分析等工作。此项工作弥补了西藏在全区放射卫生监测领域的空白,显著提高了西藏自治区疾控工作能力,对西藏放射卫生事业发展和保障放射工作人员健康具有重要意义。     

The effect of ergonomic interventions in healthcare facilities on musculoskeletal disorders

BACKGROUND: The high incidence of musculoskeletal disorders (MSDs) among healthcare workers suggests that the introduction of ergonomic interventions could be beneficial. While laboratory studies have clearly documented the efficacy of ergonomic devices, few studies have examined their effectiveness in the healthcare workplace. METHODS: This study evaluated a statewide program that provided ergonomic consultation and financial support for purchasing ergonomic devices, which aid in patient handling and lifting. Changes in MSD rates between baseline (1 year pre-intervention) and post-intervention (up to 2 years) periods were examined in 100 work units in 86 healthcare facilities. RESULTS: The median MSD rate decreased from 12.32 to 6.64 per 200,000 employee-hours, a decrease greater than the secular trend for the study period (1999-2003). CONCLUSIONS: This study suggests that ergonomic consultation and financial support for purchasing ergonomic equipment can be an effective intervention to reduce MSDs among healthcare workers.     

军事医学科研物资采购的四种意识

军事医学科研物资采购是一项系统工程，也是一项服务保障工程。优质、高效、适量的军事医学科研物资采购能为实施军事医学科研保障奠定坚实的基础。新世纪新阶段，做好军事医学科研物资采购，推进军事医学科研物资采购健康发展，必须强化科学意识，确保物资采购统筹有序；强化服务意识，确保物资采购优质高效；强化廉政意识，确保物资采购公开透明；强化保密意识，确保物资采购安全实施。     

Self assessment for practices considering electronic medical record systems

Medical practices are increasingly adopting electronic medical record (EMR) systems to help manage documentation and clinical work flow. With literally thousands of vendors and system offerings and considering the investment required for an EMR system, carefully planning for an EMR system is critical. Too often, practices transition to EMRs without an internal assessment and are then disappointed with the post-implementation results of their new system. This article outlines key questions practices should consider before purchasing a system to pave the way for optimal results.