目的 系统梳理新一轮医药卫生体制改革以来农村基本医疗卫生服务综合评价指标体系,基于PHCPI概念框架(primary health care performance initiative conceptual framework)探寻目前评价指标普遍关注的内容和可能被忽略的评价内容,为后续科学、全面地评价农村基本医疗卫生服务提供参考依据.方法 通过中国知网、万方数据知识服务平台、维普中文科技期刊数据库检索2∞9---2019年有关农村基本医疗卫生服务综合评价指标体系的文献,基于SPIDER规范制定纳入排除标准,采用批判评估技术方案对纳入文献进行质量评价,运用框架合成法,选取PHCPI概念框架对纳入的文献进行归纳和总结.结果 共纳入25篇文献,总体质量良好.评价体系中的指标可分为5个一级领域、16个二级领域、24个三级领域指标.综合对比各领域对应指标的文献数,卫生资金、效率等领域对应指标的文献数较多,均有20篇左右的文献,高于其他多数领域;投入、产出和结果的相应领域中,近85％的领域对应指标的文献在15篇及以上;服务提供的各领域中,仅18％左右的领域对应指标的文献达到15篇,40％以上领域对应指标的文献未超过5篇.结论 农村基本医疗卫生服务综合评价体系对经济效益相关指标关注度较高,投入、产出和结果多数领域的指标重合度较高,评价体系对服务提供领域的关注度较低且内容分散.今后可加强对社会效益和服务提供相关指标的探索,以全面、综合地评价农村基本医疗卫生服务.

目的 根据《县医院医疗服务基本能力标准》,利用最新全国眼科能力资源调查数据,分析我国县医院眼科基本手术能力情况.方法 从全国眼科能力资源调查数据中筛选出县医院条目,用描述性统计方法,分析我国县医院眼科具备基本手术能力的情况.结果 全国仅有10.3％的县医院具备《县医院医疗服务基本能力标准》中要求的全部5类基本手术能力,而14.7％的县医院不具备该标准中要求的5类手术中任何一类基本手术能力;从开展的手术类型来看,具备开展白内障手术能力的县医院比例最高,达到80.9％,而仅有13.9％的县医院具备开展周边虹膜激光切除术的能力.结论 我国县医院眼科基本手术能力总体情况不容乐观;各地需要积极提高县医院的眼科手术能力,同时,进一步普及对白内障的诊治能力,使全部县医院具备开展白内障手术的能力.

初级卫生保健贯穿农村卫生事业的发展历程,在不同的发展阶段中初级卫生保健均发挥了重要作用,推动农村卫生迸发出新的活力.新时期以来,初级卫生保健坚持国际认同的理念,被赋予新责任的同时不断取得令人瞩目的成绩,展现出一个高质量初级卫生保健体系所应具备的特征.展望未来,我国初级卫生保健在坚持中国特色的同时,需要进一步将中国经验向国际推广.

目的 分析全国县医院眼科设备的配置状况,并与标准比较.方法 依据《县医院医疗服务能力基本标准》和《县医院医疗服务能力推荐标准》中规定的眼科设备,利用全国眼科能力资源调查的数据,计算眼科单个设备的配置率和综合配置率.结果 单个基本设备中眼压计的配置率最高(89.62％),视野仪的配置率最低(40.69％).基本设备的综合配置率为20.31％,推荐设备的综合配置率为2.43％.东部地区单个设备配置率和综合配置率高于中部和西部地区.结论 全国单个眼科基本设备配置率不高,存在配置短板;基本设备的综合配置率极低,且单个眼科设备的配置率和综合配置率均存在明显的地区差异.

Objective To investigate the changes in doctors' remuneration and work after the setting of medical service charge. Methods We chose a third - grade class A general hospital in Beijing as the researching spot. The hospital was designated as a pilot of " service and medication separation" . We determined the samples by the snowball method, and determined the sample volume for interviews according to the information saturation principle. By in-depth individual interview method,we conducted interviews with a middle manager and 14 health workers. The interview content included the changes of remuneration distribution pattern and individual remuneration makeup after pilot program began,remuneration increment after pilot program began,changes of daily work content and work volume after pilot program began,the matching degree between remuneration and work volume and the realization degree of doctors' value. The data from interviews were coded and analyzed by MAXQDA10. Results After the pilot program began,the remuneration items of doctor were added with medical service charge, monthly remuneration of doctor increased,outpatient service volume increased,and the doctors with highest professional titles had the largest increasing range in remuneration. Internal medicine departments with drug therapy as the main service content had the largest increase in outpatient service volume,and the departments of surgery and stomatology with technical therapy as the main service content had little change in outpatient service volume. With the concurrent implementation of other policies, extraordinary prescription and unreasonable prescription were curbed to some extent. Conclusion The setting of medical service charge can increase the remuneration of doctors,realize the value of doctors,standardize the diagnosis and treatment behaviors of doctors and bring changes to the work volume of doctors in different departments.

Australian AR-DRGs is formed after the introduction and localized reform of the USA AP-DRGs,its classification of diagnosis is based on the tenth edition of International Classification of Diseases Australian version,the ICD-10-AM.Surgical operation procedures are in accordance with original Australian Coding of Surgical Operations.This paper introduced the main content and structure of ARDRGs,how a DRGs project team establishes method of systematic classification by analyzing AR-DRGs,as well as the DRGs classification result based on actual data of several hospitals,and some points which should be paid more attention in the process of location of DRG were drawn out.All this information providing guidance for domestic DRGs related researches.

The author proposed detailed introduction of handling of complications in the Australian AR-DRGs program,introduced considerations of complications by AR-DRGs from two aspect-the level of disease complications and the complexity of clinical treatments.The authors specifically described CCL and PCCL evaluations.This paper provides reference for the localization of DRGs program design.

一视同仁地将所有医疗服务都归结为政府向居民提供了"公共产品",由此造成如今神木县新的"看病难"。

<正>日本对医疗价格实行全国统一管理,这包括医疗服务价格、药品价格、医用材料价格等所有涉及医疗服务的内容。厚生劳动省的咨询机构——中央社会保险医疗协议会负责制定和定期调整相关医疗服务的价格标准和药品、医用材料的价格。日本的医疗价格形成机制及管理可为中国医疗体制改革进程中医疗价格的制定与管理提供借鉴和可能的帮助。一、医疗服务价格日本的医疗服务价格标准由《医科诊疗报酬点数表》、《老人医科诊疗报酬点数表》和《口腔科诊疗报酬点数表》三部分组成,基本把日本民众日常就诊、住院所涉及的医疗服务项目都容纳进去了,

OBJECTIVE To introduce diagnosis related groups to assess the medical quality and try to establish an effective quality evaluation approach. METHODS Using Australia-Refined Diagnosis Related Groups, version 5.0 (AR-DRGs v5.0) to classify the 160 000 discharged cases from 7 large hospitals in Beijing in 2005. Based on this, mortality risk classification was established to adjust the whole-hospital risks. And then hospital mortality of all the risk groups from each hospital was calculated respectively, which was used as the basic quality assessment criterion. The differences between the assessment results from using the raw hospital mortality and from using Diagnosis Relative Groups Mortality Risk Classification (DRGs-MRC) were compared. RESULTS (1) The risk types were different among the discharged cases in different hospitals; (2) The assessment results from these two approaches about No.6 hospital were similar in that No.6 hospital had a good quality performance; (3) The raw hospital mortality was the lowest in No.2 hospital (0.98%), but the mortality of low risk group in this hospital was higher than the average level of the same risk group among these 7 hospitals; the status of No.5 hospital was much the same. CONCLUSION Compared with raw hospital mortality, DRGs-MRC improved the comparability of cases and the reliability of the assessment result.

据媒体近日报道,深圳市第二人民医院烧伤科在治疗两名烧伤患者时,通过分解手术、滥用药品等违规行为多收工伤医疗基金161万多元.医保基金是老百姓的"保命钱",然而,类似违纪事件却频频发生.医保基金的安全痼疾已引起社会各界的反思.

2005年以来,社会上有关"看病难"、"看病贵"的谴责声越来越大,这使得医疗卫生事业深化改革的紧迫感更强,特别是当医疗保险统筹基金也开始面临基金紧张的压力时,其必然采取一系列增加基金收入、控制基金支出的政策.

Objective To explore an objective and effective method to evaluate hospital clinical services performance. Methods The inpatients' records from eight third-tier general public hospitals in Beijing during 2003-2005 were classified according to the principle of Australia Refined Diagnosis Related Groups (AR-DRGs). With the indexes based on medical charge and hospital stay, clinical services performances of these hospitals were evaluated. This study compared the performance evalutation results u-sing DRGs with that not, and then the effects of DRGs on clinical services performance evalutation were elucidated. Results Either in longitudinal comparison of a certain hospital or in transverse comparison of different hospitals, there were significant differences between the performance evaluation results using DRGs and those not Conclusion DRGs can standardize the indexes for clinical services performance and make the evaluation result more credible.

Descriptive analysis and multivariate analysis are used to analyze the outpatient expense and drugs utilization.According to the outcome of this study,the outpatient person-time,total expense,drugs cost and the capita expense all have a tendency to increasing every year.The percentage of drugs cost in the total expense has always been.about 70%;and to hypertension patients this proportion is higher (about 80%).Besides the hospital grade and the drug utilization,we find that the insurance degree also has a correlation with the outpatient expense.

Under the socialist market-oriented economic system, state-owned hospitals need to overcome many problems in their traditional management system. The authors discuss a series of issues, including the property right involved in the reform of the management system of state-owned hospitals; the relationships between nonprofit hospitals run by the government and ways of handling them; the conditions of using the corporation management structure in hospitals; the responsibilities of the government in the framework of medical services and the form in which the government supervises state-owned hospitals. Lastly, the authors put forward suggestions from the perspective of policy-making on the reform of the management system of state-owned hospitals.

Objective To Analyze the time of death in 150 cases of stroke patients retrospectively and to find out the circadian rhythm of cerebrovascular death in order to provide helpful information for clinical practice.Methods The time of death of 150 cases was analyzed by mathematical statistics.The peak time of death and the period of 95% deaths in 24 hours daily were calculated.Results The peak time of stroke death was at 05:59:56 and 95% deaths in 24 hours was located in the period from 20:21:58 to 15:37:54 of the next day.Moreover,the peak time of hemorrhagic stroke death was at 06:20:48 and 95% deaths in 24 hours occurred from 01:40:15 to 11:01:21. While for ischemic stroke, the risky time of death was at 05:59:31 and the 95% deaths in 24 hours occurred between 01:04:23 to 10:54:39.Conclusions Circadian rhythm of cerebrovascular death was noticed in this study. The risky peak time of death in stroke patients was always in the early morning. However, neurologists should consider both individual variation and medical intervention for the individual patient in evaluating the time of death. Meanwhile, clinical staff should pay more attention to monitor stroke patients in the early morning and modify some medical remedies if necessary.

根据调查和了解的数据资料,对部分手术标准进行了比较,认为就手术收费标准而言,我国现阶段部分手术的收费标准不是低了,而是偏高;相应的传统手术项目的收费标准较低,而较新开展的项目的收费标准则较高.