Health care reform in the USA: Recommendations from USA and non-USA radiologists

AIM: To compare the opinions and recommendations of imaging specialists from United States (USA) and non-USA developed nations for USA health care reform. METHODS: A survey was emailed out to 18 imaging specialists from 17 non-USA developed nation countries and 14 radiologists within the USA regarding health care reform. The questionnaire contained the following ques tions: what are the strengths of your health care system, what problems are present in your nation's health care system, and what recommendations do you have for health care reform in the USA. USA and non-USA radiologists received the same questionnaire. RESULTS: Strengths of the USA health care system include high quality care, autonomy, and access to timely care. Twelve of 14 (86%) USA radiologists identified medicolegal action as a major problem in their health care system and felt that medicolegal reform was a critical aspect of health care reform. None of the non-USA radiologists identified medicolegal aspects as a problem in their own country nor identified it as a subject for USA health care reform. Eleven of 14 (79%) USA radiologists and 16/18 (89%) non-USA radiologists identified universal health care coverage as an important recommendation for reform. CONCLUSION: Without full universal coverage, meaningful health care reform will likely require medicolegal reform as an early and important aspect of improved and efficient health care.

The innovations in China’s primary health care reform: Development and characteristics of the community health services in Hangzhou

Objective:This study focuses on Hangzhou,a Chinese city with a population of nine million urban and rural residents,to examine the successful development and innovation experience of its primary health care service system during the new health reform in China since 2009 and then dis-seminate the findings through international third parties.Methods:Measures such as data analysis,study of documents and regulations,fieldwork,and expert discussions were used to systematically investigate primary health care in Hangzhou.The findings will have a profound practical impact on the health reform for nine million rural and urban residents throughout Hangzhou’s municipal boroughs.Results:Community health services in Hangzhou are characterized as follows:They are gov-ernment led;they are guaranteed with enough financing,personnel,facilities,and regulation;sup-ported by the unified information platform;general practitioners have been assigned the key role of health‘gatekeepers’;they provide primary care combined with basic public health services;there are integrated urban and rural health services and insurance coverage;and there is health care-pen-sion-nursing integration and general practitioner-contracted‘smart’services.Preliminary data collection and analysis indicate that the basic health status of Hangzhou residents is superior to that of residents of China as a whole,and some health indicators in Hangzhou are comparable to those in Western developed countries.Conclusion:It is reasonable to believe that the primary health care level in China,including Hangzhou,will be further developed and promoted with indexed performance evaluations and more effective implementation of additional measures.

Health professionals’perspective on the impact of community health care reform in different regions of China

Objective:Changes in supplying community health services,degree of satisfaction,and pol-icy suggestions are presented from the perspectives of health professionals in different regions of China with the purpose of further facilitating comprehensive reform of community health services.Methods:Based on geographic location and economic level of development,eight cities were selected and 12 community health service institutions were chosen by random sampling from each city.A questionnaire survey was conducted by the health professionals.Results:With respect to working enthusiasm,reduction in antibiotic drug use,social image and trust of patients,more health professionals in middle and western China showed positive feed-backs than those in eastern China.With respect to preliminary results of the reform,performance and salary,and health care insurance policies,health professionals’satisfaction levels in middle and western China were higher than in eastern China.The health professionals in middle and western China were more concerned about equipment,infrastructure and increasing training op-portunities.The health professionals in both eastern and middle China accentuated improving the variety of essential drugs covered by health insurance,while health professionals in eastern China suggested performance-related payment reform.Conclusions:The performance of health professionals in middle and western China was improved more signifi cantly through comprehensive reform than that of health professionals in eastern China.For health professionals in middle and western China,it is essential to strengthen infrastructure and increase professional training,while health professionals in middle and eastern China would like to see an increase in the variety of essential drugs,and those in eastern China require strengthening performance-related payment reform.

健康中国背景下的“看病贵”与政府支出——基于资源配置结构性失衡视角的分析

“看病贵”意味着医疗卫生资源转化为医疗卫生服务的成本高,有限资源下医疗卫生服务供给的数量和质量难以满足公众健康需求,从而直接影响健康中国建设。同时,人口快速老龄化带来的医疗卫生需求爆发式增长,将形成医疗卫生体系的额外压力,加剧供求矛盾。基于医疗卫生资源配置结构性失衡视角研究“看病贵”与政府支出之间的关系发现:政府增加卫生支出会通过加剧人力资源配置的结构性失衡而加剧“看病贵”问题;只有将增加政府卫生支出与深化医疗卫生体制改革相结合,才能真正缓解全社会“看病贵”问题。因此,应深化公立医院改革,优化政府对医疗卫生资源的配置方式,加强基层医疗卫生体系建设,重塑医疗卫生服务治理模式,构建专业化治理模式,系统性重构中国医疗卫生领域人才建设。

北京市综合医改前后社区卫生服务机构治疗费用的受益人群分析

背景厘清社区卫生服务机构主要服务的人群特点,对下一步社区卫生服务机构的精准改革具有十分重要的意义。目的通过分析综合改革前后北京市社区卫生服务机构治疗费用的受益人群特征,为下一步改革政策制定和调整提供精准的数据支持。方法本研究基础数据来源于2016—2019年北京市卫生总费用核算基础数据库,其他数据来源于2016—2019年《北京市卫生健康统计年鉴》《北京市卫生财务统计年报》《北京市卫生费用核算报告》等。采用多阶段分层整群抽样的方案选取社区卫生服务机构,从HIS系统纳入全年的门诊数据、住院患者的数据。采用卫生费用核算体系2011(SHA2011)核算、分析社区卫生服务机构治疗费用的受益人群状况。结果2016—2019年北京市社区卫生服务机构治疗费用从121.81亿元增长至222.45亿元,年均增长19.07%。40岁以上中老年患者治疗费用历年占比均在92%以上,60~岁、80~岁两个年龄组患者治疗费用增长较快,年均增速分别为24.08%、25.84%;治疗费用中内分泌、营养和代谢疾病,症状、体征和检验异常、循环系统疾病占比最高,内分泌、营养和代谢疾病,神经系统疾病,症状、体征和检验异常疾病治疗费用增长较快,年均增速分别为40.11%、48.40%和32.43%。结论综合改革后分级诊疗成效初显,社区医疗服务资源主要由中老年患者、内分泌、循环系统等慢性非传染性疾病患者所消耗,改革引导更多中老年和慢性病患者流向社区,社区卫生服务机构应该从服务能力、人才队伍、慢性病管理、医联体建设等多方面着手,提升其服务能力,巩固和维持改革的效果。

新加坡安宁疗护服务发展经验及其对我国的启示

安宁疗护是保障终末期患者善终权益,提升终末期患者生活质量的有效手段之一。新加坡安宁疗护发展迅猛,目前已逐步建成完善的安宁疗护服务体系,并在最新发布的国家死亡质量排名中位于亚洲前列。本文通过梳理新加坡安宁疗护现状,公众宣教、人才培养、慈善支持以及相关政策法律保障等方面的实践经验,最终提出我国应加强安宁疗护的社会认知、教育培养,发挥慈善团体和非政府组织的力量,提高现有安宁疗护承载力,构建安宁疗护相关制度和法律保障,以期达到实现终末期患者善终需求的目的。

紧密型托管模式下优质医疗资源下沉的实践与探索

目的探讨紧密型托管模式的特点及优势,为推动优质医疗资源下沉提供经验和建议。方法通过文献分析,梳理出我国医院托管改革的历程及特点,结合“结构-过程-结果”理论,通过比较研究法,比较分析紧密型、半紧密型和松散型托管模式的差异,归纳总结出紧密型托管模式的主要特点及优势;并通过对山东省某大型省属三甲公立医院紧密型托管模式的案例剖析,深入探讨紧密型托管模式的具体实践措施、成效及存在的问题。结果紧密型托管模式通常是政府全面托管,托管医院按照院区形式实行统一领导,在人事管理、财务管理、业务管理、信息化等方面趋于一体化、同质化,托管关系较为稳定,实施效果较好。结论紧密型托管模式更有利于实现大型公立医院品牌、人才、技术、信息等优质医疗资源要素向基层流动,是新时期推动优质医疗资源扩容下沉和区域均衡布局的一种有效方式。

Finance Policy for Public Health Disease Prevention: Addressing the Number One Cause of Death in the Western World

Background: The lack of a finance policy to cover heart coronary artery disease CT imaging led to an epidemic of heart disease, the most common cause of death in the United States. The difficulty for many adults to pay $150 for CT heart imaging was the impetus for public health reform through legislative intervention. Methods: The key to finance policy reform was the organization of the medical environment involved in asymptomatic heart disease. Using the ecosystem paradigm for organizational alignment, the legislative goal was financing the $150 heart image to identify and medically prevent symptomatic heart disease, obviating future surgical costs of >$100,000. Results: Assisted by stakeholders for public health reform, a 3-year initiative to pass a legislative bill mandating health insurance coverage of $150 heart imaging was signed into law. Understanding the legislative process was necessary for successful advancement of public health and eliminating unnecessary costs of an established conservative ecosystem. Conclusions: Texas was the first state to achieve this legislative goal and New Mexico soon followed. If political environments, regardless of country following this road map of public health reform, a significant beneficial impact upon heart disease, its cost, and healthier public would result.

加强乡村医疗卫生体系建设提升基层医疗卫生服务能力

2023年中共中央办公厅、国务院办公厅印发《关于进一步深化改革促进乡村卫生医疗体系健康发展的意见》提出了构建紧密型县域医共体,致公党辽宁省委会、大连市委会成立了专门课题组,对大连地区县以下医疗卫生体系建设情况进行调研,梳理出问题所在,并提出了具体建议与解决方案。

DRGs付费制度对医院绩效管理的影响及对策研究

在我国医疗改革的大背景下,基于疾病诊断相关分组(diagnosis related groups,DRGs)付费制度的推广与实施为医疗行业带来了新的挑战与机遇。这种付费方式不仅改变了医院传统的收入模式,还对医院的绩效管理产生了深远的影响。文章旨在深入探讨DRGs付费制度对医院绩效管理各个方面的影响,包括医院收入结构、医疗质量提升、医疗资源的有效利用以及医疗成本控制等。经过全面而系统的分析,阐明了DRGs付费制度对医院绩效管理所带来的多重挑战。这些挑战不仅涵盖了医院收入结构的调整、医疗服务质量的提升,还涉及医疗资源的有效利用以及医疗成本的控制等方面,对医院的运营和管理提出了更高的要求。针对这些问题,文章提出了一系列对策建议,旨在帮助医院在DRGs付费制度下优化绩效管理体系,实现科学、合理的绩效管理,从而提高医院的可持续发展能力。

英格兰医疗卫生系统改革述评

2020年,在新冠疫情大流行期间,由于被指责对疫情的检测和追踪工作不力,英格兰公共卫生署被英国政府撤销,这引起了人们对英国,尤其是英格兰地区公共卫生系统未来的担忧。为取代英格兰公共卫生署,新成立的两个机构迅速反思了该机构之前的问题,以确保建立一个适合于既定目标的公共卫生系统,避免与之前的英格兰公共卫生署遭遇类似的命运。本文分析了目前英国政治体系存在的几个系统性弱点,包括本位主义、执行不力、领导决策手段缺失或不愿面对真相,以及以牺牲长期计划为代价的功利主义,并对新成立机构的运行进行了评价。

医疗改革对医院价格管理的影响与研究

在我国大力推动社会主义现代化建设过程中,针对人民群众普遍关切的“看病难、看病贵”的难题,国家出台了一系列可行性重大举措来深化医疗卫生体制改革。在这一背景下,医院价格管理成了一个备受关注的话题。医疗改革给医院价格管理带来了深远的影响,不仅改变了医院收费结构,也减轻了患者的费用压力。鉴于此,文章将立足于医疗体制改革环境,结合具体实例,深度剖析当前医院价格管理中存在的问题及影响,旨在为医院价格管理的改革与创新提供有益的建议。

O-AMAS有效教学模型在学前儿童卫生与保育课程教学中的应用研究

目的探讨O-AMAS有效教学模型在学前儿童卫生与保育课程教学中的应用效果。方法以学前儿童卫生与保育课程为例,对绍兴文理学院学前教育专业的学生分别采用传统授课模式(对照组)和基于O-AMAS有效教学模型的授课模式(实验组)进行教学。通过比较2组学生的总评成绩和课程满意度,评估教学效果。结果实验组学生的平均总评成绩显著高于对照组(P<0.001)。在课程满意度方面,实验组学生“激发学习兴趣,鼓励创新”“重视知识理解,强调学以致用,培养应用能力”“重视教学活动互动性,培养沟通及团队协作的素养”维度的满意度评分均显著优于对照组(P<0.05)。相关分析结果显示,实验组学生“重视知识理解,强调学以致用,培养应用能力”和“学业负担合理度”维度的满意度评分与学生总评成绩显著相关(P<0.01)。结论OAMAS有效教学模型在学前儿童卫生与保育课程教学中的效果显著,能有效提升教学效率、课程满意度及学业成绩。

“岗课赛证”融通下的高职智慧健康养老服务与管理专业人才培养模式研究与实践

当前,我国养老服务产业进入新蓝海,为高职养老服务类专业提供了广阔的发展空间,但与用人需求相对应的是,高职智慧健康养老服务与管理专业发展还存在供需不匹配、岗课不对接、留存不理想、认同不到位等问题,通过推进“岗课赛证”综合育人改革,进一步优化顶层设计、深化产教融合、强化以赛促学、推行以证代评、健全体制机制,可为养老服务产业培养和输送大批高素质复合型技术技能人才。

深化医改 推动上海卫生健康高质量发展

介绍近年来上海卫生健康领域改革的实践成效,梳理当前面临的问题挑战,有针对性地提出下一阶段持续深化医药卫生体制改革的方向举措,以期推动上海卫生健康事业高质量发展。

植根基层 服务基层——长沙市暮云街道社区卫生服务中心设计

随着我国医疗卫生事业的蓬勃发展,以社区卫生服务中心为代表的基层医疗机构已发挥越来越重要的作用,成为大型综合医院的有力补充。该文以长沙市暮云街道社区卫生服务中心设计为例,着重阐述了建筑、结构、机电等各专业的设计要点和应对策略,为今后类似项目提供参考和借鉴。

价值护理的研究进展

价值导向型医疗已成为医疗体系改革的重点。护理管理者面临成本、质量等多重压力,影响护理服务价值。目前,价值护理研究仍处于起步阶段,尚无公认概念,缺乏相关测量指标。该文综述了价值护理的概念、研究起源及意义、测量指标等内容,分析了价值护理在临床转化中的应用策略,未来研究中应进一步梳理价值护理的内涵驱动与临床转化,形成统一规范管理。

The Malaysian health care system:Ecology,plans,and reforms

Malaysia is on its way to achieving developed nation status in the next 4 years.Currently,Malaysia is on track for three Millennium Development Goals(MDG1,MDG4,and MDG7).The maternal mortality rate,infant mortality rate,and mortality rate of children younger than 5 years improved from 25.6%(2012)to 6.6%(2013),and 7.7%(2012)per 100,000 live births,respectively whereas immunization coverage for infants increased to an average of 90%.As of 2013 the ratio of physicians to patients improved to 1:633 while the ratio of health facilities to the population was 1:10,272.The current government administration has proposed a reform in the form of the 10th Malaysian Plan coining the term“One Care for One Malaysia”as the newly improved and reorganized health care plan,where efficiency,effectiveness,and equity are the main focus.This review illustrates Malaysia’s transition from pre-independence to the current state,and its health and socioeconomic achievement as a country.It aims to contribute knowledge through identifying the plans and reforms by the Malaysian government while highlighting the challenges faced as a nation.