在医保支付方式深化改革的大背景下,疾病诊断相关分组(diagnosis related groups,DRG)作为医保改革的关键政策,在其推进落实的过程中如何体现出控费和提质的双重导向,公立医院如何解读与应对,已成为新时期医疗卫生领域的“必答题”。文...在医保支付方式深化改革的大背景下,疾病诊断相关分组(diagnosis related groups,DRG)作为医保改革的关键政策,在其推进落实的过程中如何体现出控费和提质的双重导向,公立医院如何解读与应对,已成为新时期医疗卫生领域的“必答题”。文章将多源流理论与标尺竞争理论有机结合,构建理论分析框架,定性推导出DRG控费提质双重导向在理论上的合理性和必要性,同时得到现阶段尚存在矛盾点的结论。通过医保、医管双视角,对DRG改革中控费和提质矛盾点产生的原因进行分析与细化,再提出对策建议,为进一步完善与落实DRG政策提供支持。展开更多
The indentation test is a localized testing technique;therefore,the role of the material size-effect and local non-uniformity is of much importance.The influence of the heterogeneity in size-independent materials has ...The indentation test is a localized testing technique;therefore,the role of the material size-effect and local non-uniformity is of much importance.The influence of the heterogeneity in size-independent materials has been studied previously.The present work detailedly investigated the influence of the material size-effect and heterogeneity(inclusions near the indenter tip)on the indentation hardness using a size-dependent strain gradient plastic theory.And it was found that when considering the material size-ffect,shallow hard inclusions in the heterogeneous materials more significantly enhance the material indentation hardness compared with the size-independent materials which are based on the conventional plastic theory.This hardening effect is be-lieved to be related to the elevation of the load and local constraints of large deformation.The effect of material inhomogeneity mainly comes from the non-uniformity of the structure rather than the inclusion modulus itself especially when the size-effect is involved,and the transition range of the inclusion modulus'influence is pretty narrow.The effect of non-uniformity becomes negligible after the initial inclusion depth is larger than its diameter.The horizontal offset of the indenter from the inclusion is also of much sensitivity to the influence of the heterogeneous indentation.This paper focuses on the scaling relationships in micro-and nanoindentation,the influence of non-uniformity in microscopic materials is studied and supplemented as well.展开更多
文摘在医保支付方式深化改革的大背景下,疾病诊断相关分组(diagnosis related groups,DRG)作为医保改革的关键政策,在其推进落实的过程中如何体现出控费和提质的双重导向,公立医院如何解读与应对,已成为新时期医疗卫生领域的“必答题”。文章将多源流理论与标尺竞争理论有机结合,构建理论分析框架,定性推导出DRG控费提质双重导向在理论上的合理性和必要性,同时得到现阶段尚存在矛盾点的结论。通过医保、医管双视角,对DRG改革中控费和提质矛盾点产生的原因进行分析与细化,再提出对策建议,为进一步完善与落实DRG政策提供支持。
基金the National Natural Science Foundation of China(Grant Nos.11890681,12032001,and 11521202).
文摘The indentation test is a localized testing technique;therefore,the role of the material size-effect and local non-uniformity is of much importance.The influence of the heterogeneity in size-independent materials has been studied previously.The present work detailedly investigated the influence of the material size-effect and heterogeneity(inclusions near the indenter tip)on the indentation hardness using a size-dependent strain gradient plastic theory.And it was found that when considering the material size-ffect,shallow hard inclusions in the heterogeneous materials more significantly enhance the material indentation hardness compared with the size-independent materials which are based on the conventional plastic theory.This hardening effect is be-lieved to be related to the elevation of the load and local constraints of large deformation.The effect of material inhomogeneity mainly comes from the non-uniformity of the structure rather than the inclusion modulus itself especially when the size-effect is involved,and the transition range of the inclusion modulus'influence is pretty narrow.The effect of non-uniformity becomes negligible after the initial inclusion depth is larger than its diameter.The horizontal offset of the indenter from the inclusion is also of much sensitivity to the influence of the heterogeneous indentation.This paper focuses on the scaling relationships in micro-and nanoindentation,the influence of non-uniformity in microscopic materials is studied and supplemented as well.
