2022年1月8日,上海汾阳路肇嘉浜路口好望角大饭店的会议厅,窗外寒风凛凛,屋内暖意浓浓.已经坚持了 15年,办到第61期的复旦大学医院管理研究所的学术沙龙上,来自上海市卫生健康委员会、上海市医疗保障局、上海申康医院发展中心(以下简称申康中心),以及全国的医院管理者们齐聚一堂,围绕着国家五部委联合签发的《关于深化公立医院薪酬制度改革的指导意见》,在3位学者、医院管理者引导发言后,沙龙成员们正在唇枪舌剑地探讨着这次公立医院薪酬改革的内涵、意义和要点.我的思绪则已飞回遥远的过去,回眸自己作为医生、医院管理者到医改参与者的公立医院薪酬改革亲历之路.

Discipline evaluation is an important measure to promote the virtuous circle of discipline construction, and is an indispensable link in the process of discipline development in public hospitals. After becoming a directly affiliated hospital of a " double first-class" university, in order to improve the comprehensive strength and influence, a hospital built and applied a disciplinary evaluation system in four directions: talent construction, clinical medicine, scientific research ability, and teaching work. According to the evaluation results, the hospital′s disciplines were divided into three categories, namely, advantageous disciplines, cultivating disciplines and potential disciplines, and development strategies were established at different levels, providing policy support and financial support, especially in the field of scientific research and teaching, to accelerate to make up for shortcomings. Through exploration and practice, the talent team, scientific research and teaching level, discipline reputation, and comprehensive strength of the hospital had been significantly improved, providing effective support for the high-quality development of the hospital.

一场疫情使复旦大学附属华山医院(以下简称华山医院)感染科主任张文宏成了网红"男神".作为"上医人"是由衷为他骄傲和自豪的.这里有他的人格魅力,更有华山医院感染科几十年的学术底蕴. 谈及华山医院感染科,我脑海中似乎打开了一本有些泛黄的记忆相册:戴自英、徐肇玥、汪复、张婴元、翁心华、张清波教授等一个个栩栩如生的上医感染科大家;还有伴随着华山医院感染科发展而纠缠的传染科还是感染科的学科方向之争的艰辛历程.

我在讲授《医院管理者的职业规划》课程时,常会提问:你为什么要做干部?其涵义是了解从事医院管理的动机和目的,不忘初衷,做好职业规划.2021年4月初的春夜,我在赛里木湖的房车露营地的星空房里望着满天繁星,把这个问题抛给自己,思绪回到了自己在儿科医院开始从事医院管理的岁月,发现整个过程充满了偶然、冲动和懵懂.

2005年6月,那是我严格意义上第一次走进康定路2号的康定花园.时任复旦大学眼耳鼻喉科医院院长的我,被邀请参加由上海申康医院投资公司委托,复旦大学公共卫生学院承担的《公立医院绩效评价指标体系》课题研究.

高解春教授近年来写过两本书，《所见所悟》和《雪泥鸿爪》。前一本是游历+游学，后一本仿若灯下随笔、人生随想。单论书名，互为表里，拿来随意置换也说得过去：人生是条单行线，一路走来，其所见所悟，岂非就是雪泥鸿爪？读过他的文字，听过他的讲座，深感于指东打西信马由缰之时，总能拽出主线扣住主题不放的功力，非比寻常。业余时间，高教授喜欢摄影，那他一定是知道散点式构图了。如果把儿科医生到医院管理研究所掌门人之间的职业生涯，以及治学经历、兴趣爱好，凡此种种，全部简化为大小、形状、排列不一的各式散点，这样的“构图”，看似自由奔放，倒也暗合了“光影的逻辑关系”，其内生的冲击力，呼之欲出。尤其让人感佩的是，退出领导岗位后，高教授依然保有了学习新知识新技能的热情。既如此，从叙事的角度，简略钩沉身为医院管理者的种种过往，观者自能获得教益不必多说，作者本人或能温故而知新也未可知。王一方教授说，叙事医学的高地在中国。由高解春教授亲自执笔、本期开篇的医管叙事系列，即为明证。

2006年8月,上海市康定路2号,那座1923年建造的康定花园中,盛夏的蝉鸣让人感觉有些聒噪.红瓦白墙的3幢老洋房依然优雅地矗立着,半圆形的外挑露台、白色罗马柱后的三开大门,尽显作为上海优秀保护建筑的艺术特色和人文沉淀.这里,1年前已成为了全国率先探索公立医院管办分开的新生事物——上海申康医院发展中心(以下简称申康)的办公地.

2006年12月,初冬清晨的美国波士顿,气温已近冰点,街边挺拔的北美榆树早已凋谢,在寒风中轻轻摇曳.约莫20多位中国人,穿梭在象征着美国教育文化的波士顿褚红色建筑群中,一边踩着霜露疾走,一边小声地争论着什么话题.这是由哈佛大学公共卫生学院(以下简称哈佛公卫学院)与原中国卫生部合作举办的第一期"中国医院国际高级研修班"学员,以上海申康医院发展中心所属医院为主的多家医院26名管理者将在这里进行为期20天的交流学习.我有幸成为这个中国医院"哈佛一期"的中方团长,而美方项目负责人就是时任哈佛大学公卫学院高级讲师,后来回国担任北京协和医学院卫生健康管理政策学院执行院长的刘远立.

通过构建以学科建设为核心的管理机制、完善人才发展路径、着重培养研究性医生、建立完善的学科激励政策以及加强临床与基础的融合等措施有助于医院提升医院的学科建设水平.本研究采用SWOT分析方法 以2019年复旦大学医院管理研究所在我院开展的第三方学科评估为契机,调研儿科医院学科建设现状,以及面临的主要问题,并通过文献分析和调研整理总结国内外高水平医疗机构学科发展的先进经验,旨在探讨儿童专科医院学科建设的主要思路并提出策略建议.

世界卫生组织评价芬兰是公认的儿童健康服务领域国际领军者,在公共健康政策特别是儿童健康政策制定和规划方面有坚实的基础.本文介绍芬兰儿童全程医疗保健的先进服务模式和管理经验,包括分级诊疗有序运转、公共卫生护士在全程化管理中发挥的关键作用、重视社会和家庭环境对儿童健康发展的影响、多部门协作推进的儿童健康和福利服务整合等,并从强化儿童健康法律和政策保障、加强妇幼保健体系网底建设和三级联动、以儿科医联体建设为切入点深入推进分级诊疗、持续完善多部门协作工作机制、充分发挥信息化手段和家庭的作用等方面,提出我国儿童健康服务能力建设的可借鉴之处和建议.

Objective To develop a set of structure and process indicators to evaluate tertiary hospitals’ performance in the Healthcare Improvement Initiative, a national program with a goal to improve quality of patient-centered care. Methods A modified Delphi technique, including literature review, multidisciplinary panel meeting and anonymous rating, was used to generate a set of indicators. A practice test involving both general and special hospitals was conducted to ensure the feasibility of data collection for these indicators. Results 62 indicators were generated by literature review. The panel review procedure involving 39 panelists with diverse backgrounds resulted in a total of 59 indicators, which included 40 qualitative indicators and 19 quantitative indicators. In the practice test, six quantitative indicators were found unfeasible. According to the suggestion of the experts in the hospital evaluation committee, three of those indicators were kept by adjusting their data collection methods, while other three ones were discarded. Discussion A set of 56 structure and process indicators was developed to evaluate hospitals’ performance in the implementation of the Healthcare Improvement Initiative, which could be used in both general and special tertiary hospitals. Results of the indicator measurement could present a panorama of the quality of patient-centered care in tertiary hospitals nation-wide, and inform health administrators of the ways to attain the goal of the Initiative.

近日,有媒体报道,山西省有3家三级医院自愿申请降级为二级医院,从而可以作为分级诊疗首诊医院,并执行二级医院收费标准.不寻常的医院主动降级,折射的是公立医院改革对医院定位、战略、医疗行为的冲击,考问的是我们现有医疗体系、管理模式、评级制度、引导机制的问题. 考问一:政府医疗服务体系规划是否缺位? 传统的计划经济和行政管理模式,使我国的医疗服务体系和医疗资源配置中多头财政、多级行政现象严重.

has had increasing credibility with the people and hospitals in China.It helps patients choose a hospital most suited for them to meet with their medical demands, and helps set a benchmark for the development of hospitals.This paper will detail the Chinese hospital ranking method from the aspects of theoretical framework, practical choice and practical effect.Method: Social reputation is used to reflect "process" and the ability to develop sustainably is used to reflect "structure", and in combination, these two dimensions determine the Chinese hospital rankings. Results:The final results conclude four different hospital ranking lists, including 'the hospital reputation rankings of each clinical specialty', 'the hospital reputation rankings', 'the hospital comprehensive rankings', and 'the regional hospital comprehensive rankings', which are published yearly. Conclusions: With the development of Chinese hospital rankings produced by the Hospital ManagementInstitute, its credibility is constantly growing.What's more, it brings great social effects.First, for patients, it provides some useful information about hospitals when they contract severe diseases.Second, for hospitals, it helps to set the benchmark, which will help medical specialized development.Third, it is used as reference of unit performance assessment within a hospital.Fourth, for the local governments, it serves as a guide to the disciplinary construction of medicine in the region.

Objective To study the demand and utilization of the Internet healthcare of patients in western rural China,and to give advice on it.Method Based on the patient questionnaire of 400 patients in 3 county-level medical institutions in Yunan Province,analyzing the factors of the demand on telemedicine,calculating the standardized demand proportion,and to estimating the telemedicine market.Result Under modified age,occupation and educational background,the standardized proportion of demand on telemedicine is 28.5％ in western rural China.The medical potential market can reach 17.6 million person-times and 400 million Yuan in rural areas in Yunnan,Guizhou and Sichuan.Conclusion The development of telemedicine has an important significance for the increase of high-quality medical resource in western rural China.At present,telemedicine has a major market demand in western rural China,so government should pay attention to and encourage the development of telemedicine in western rural China.

当围棋机器人AlphaGo横扫世界职业围棋高手,以60战全胜的战绩让人T智能再次成为世界瞩目的焦点;当谷歌无人汽车和无人白行车的试验视频给人们无比的震撼;当互联网商购、互联网金融、互联网T业、互联网媒体开展得如火如荼之时,人们对关系到自身健康的互联网医疗的热切期盼,使其必然成为焦点.那么,对于互联网医疗的概念梳理、政策谋划,尤其是实施途径的探讨,就显得意义非凡.

Objective To study the demand and status of telemedicine in western rural China to provide strategies for telemedicine development in western area.Method Doing questionnaire survey on 153 physicians in a county in Yunnan Province.Result 81.7％ physicians are willing to provide telemedicine,while 15.0％ are providing such service.Medical quality,infrastructure and training are the main considerations.Conclusion There is a huge gap between the willingness and the status to provide telemedicine in western rural China.The government should promote legislation,establish the diagnosis and treatment norms and regulatory system,build the service system,and strengthen the training.

《公立医院领导人员管理暂行办法》出台后,对于《管理办法》的解读五花八门:有人把主语是“领导人员”而非“管理人员”注释为,改革注重政府导向而非现代化管理制度;有人把打破身份限制、吸引优秀人才理解为,鼓励把民营医院院长作为公立医院领导人员选拔对象;有人将有条件的地方实行年薪制断定为,年薪制不是方向……

随着年龄增长,健康状况和医疗需求发生改变,老龄化将给医疗服务体系带来挑战. 国内多项研究结果显示,老年人口的人均医疗费用比其他年龄组高[1-3] ,经济负担较其他人群重. 面板数据分析认为老龄化解释了人均医疗支出增长变化中的3. 9% [4]. 然而,目前研究还不能回答老年人口究竟需要多少医疗费用这一问题. 本文介绍了结合寿命表模型来模拟终生医疗费用的方法,为相关研究提供借鉴.

The doctor-patient relationship plays an important role in protecting lawful rights and interests of both doctors and patients.Through literature analysis and expert consultation,the problems in establishing are figured out and advice on it is proposed based on American experience and the situation of China.The telemedicine has challenged traditional doctor-patient relationship by changing the subject,condition and identification.The government should allow and formulate a stricter way to establish doctor-patient relationship in telemedicine,and promote the legal and technical means way to identify it.

The need for formal care among the elderly population has been increasing due to their greater longevity and the evolution of family structure. We examined the determinants of the use and expenses of formal care among in-home elderly adults in Shanghai. A two-part model based on the data from the Shanghai Long-Term Care Needs Assessment Questionnaire was applied. A total of 8428 participants responded in 2014 and 7100 were followed up in 2015. The determinants of the probability of using formal care were analyzed in the first part of the model and the determinants of formal care expenses were analyzed in the second part. Demographic indicators, living arrangements, physical health status, and care type in 2014 were selected as independent variables. We found that individuals of older age; women; those with higher Activities of Daily Living (ADL) scores; those without spouse; those with higher income; those suffering from stroke, dementia, lower limb fracture, or advanced tumor; and those with previous experience of formal and informal care were more likely to receive formal care in 2015. Furthermore, age, income and formal care fee in 2014 were significant predictors of formal care expenses in 2015. Taken together, the results showed that formal care provision in Shanghai was not determined by ADL scores, but was instead more related to income. This implied an inappropriate distribution of formal care among elderly population in Shanghai. Additionally, it appeared difficult for the elderly to quit the formal care once they begun to use it. These results highlighted the importance of assessing the need for formal care, and suggested that the government offer guidance on formal care use for the elderly.