The report of the 20th National Congress of the Communist Party of China clearly proposes to promote the construction of a healthy China and give priority to the development of ensuring the health of the people. Based on the study of the spirit of the 20th National Congress of the Communist Party of China, this paper expounds the reasons for promoting the supply-side structural reform in the health field, and proposes five turns reform paths and policy tools available, including the compensation mechanism that relies on government for development and relies on service for operation, the medical insurance payment tool with reasonable total amount, scientific classification,and strong guarantee, the dynamic adjustment mechanism of medical service price classification based on taking small steps without stopping, the planning tools for optimizing increment, adjusting inventory, and improving quality, and scientific, standardized, refined, and digital operation management tools.

目的:探讨疫情常态化防控期间某儿童医院门诊医疗投诉的具体情况,并在实践中不断完善相应的处理措施,提高儿童医院门诊服务质量.方法:梳理某儿童医院2020年和2021年受理的1413例投诉,分析不同年份投诉数量、投诉原因的变化.结果:门诊投诉例数从2020年的578例上升至2021年的835例,门诊投诉率从2020年的2.78(‰)上升至2021年的3.13(‰).门诊投诉原因中,医疗资源、医院管理和医疗质量所占比例由2020年的32.70％、13.84％和4.50％上升至2021年35.93％、28.38％和5.27％,医患沟通和医院制度所占比例同比下降6.05％、11.57％.结论:疫情常态化防控时期,医院更应高度重视门诊投诉,分析总结投诉原因,加强门诊管理,优化服务模式,提高医疗服务质量.

目的:评估我院自制产品参芪口服液治疗幼儿中性粒细胞减少症的效果.方法:回顾性收集我院2019年6月至12月间确诊中性粒细胞减少症的门诊患儿的一般资料,按照治疗方式不同将其分为参芪组、地榆组和空白组,对各组进行相应治疗,观察疗效并比较.结果:参芪组和地榆组治疗幼儿中性粒细胞减少症有效率分别为87.5％和88.1％,两组疗效差异无统计学意义,但两者疗效均优于空白组的72.6％,差异有统计学意义(P＜0.05).治疗后参芪组与地榆组中性粒细胞绝对值计数分别为(1.94±0.45)×109 L-1和(1.93±0.39)×109 L-1,均较空白组的(1.83±0.35)×109 L-1显著提高,差异有统计学意义(P＜0.05).结论:参芪口服液能补中益气、扶正祛邪、补血活血,其治疗中性粒细胞减少症疗效确切.

推进供给侧结构性改革是对推进卫生健康事业质量变革、效率变革、动力变革具有重要意义.在内涵上,借鉴经济领域的分析视角,采用"卫生健康+供给侧+结构性+改革"拆词法进行研究.在改革方向上,以问题和结果为导向,利用国内外公开数据估测了建设强大的公共卫生体系、优化病人流向结构、改善医疗收入结构、提高人员经费支出占比和发展健康产业等5个方面供给侧结构性改革的潜在红利.在逻辑框架上,采用"问题-结构-对策"的分析范式,从价值取向、改革内容、政治保障、制度支撑和改革动力等方面提出建议.

目的:探讨南京医科大学附属儿童医院抗生素合理应用管理的有效性.方法:随机抽取2016年、2019年支气管肺炎病例216例和420例作为对照组和观察组,在相同对症治疗的基础上,对照组抗生素以每日总剂量静脉滴注1次·d-1,观察组按次均剂量降阶梯输液1次·d-1,同期口服抗生素,疗程均为7 d.依据观察组口服抗生素是否序贯分为降阶梯+序贯口服组、降阶梯+非序贯口服组,对各组疗效进行分析.结果:降阶梯+序贯口服组疗效与对照组差异无统计学意义,提示规范降阶梯治疗并不降低疗效.而降阶梯+非序贯口组服疗效较另外两组差,症状消失时间长,不良反应多.结论:儿童医院门诊患儿抗生素降阶梯静脉滴注加规范序贯口服,具有良好的疗效,并能提高依从性,减少治疗费用,减少不良反应,降低耐药性.

目的:分析某三甲儿童医院2015年-2019年门诊人次变化特征,为提高医院管理效能,优化服务流程,合理配置医疗资源提供科学依据.方法:对医院门诊量按时间序列分析法和季节指数法进行统计,分析门诊量年度、季度、月度的变化情况.结果:医院门诊量近5年逐年升高,平均发展速度为108.22％,季节指数显示2月份和12月份分别为每年的最低谷(80.15％)和最高峰(118.63％),一季度和四季度分别是全年的最低(93.69％)和最高(107.09％).结论:医院门诊量有明显的季节性和周期性特点,每年在一季度出现低谷,四季度迎来高峰,暑期为次高峰.医院管理者应根据此特点合理配置医疗资源,人员错峰休假、弹性排班,高峰期做好实时监测和应急方案,低峰期拓展服务形式,更好地满足患者就诊需求.

This study applied both qualitative and quantitative research methods to describe Norwegian health care reform, covering such performance indicators as key reform process, healthcare reform trends in number of beds per thousand, health care resource utilization, hospital management system, general practitioners, and public health management system. Moreover, the paper put forward suggestions for the reform in China, namely health governance mechanism, the transformation from scale expansion to quality and performance-based development, reforming family physician system.

《高传炉》壶嘴的造型是方中带圆的基本形制,三弯流造型较其他壶流造型又富于变化,壶嘴的巧妙造型最能体现制壶艺人壶艺手法.圆把挺而有力,刚柔相济.此壶“大巧若拙,大象无形”,悠悠古韵盎然,虚实相间,方圆交替,妙不可言.

This paper summarized health care delivery system in remote areas of Japan including criteria for underserved areas, regular adjustment to the list, comprehensive national plans, integrated provision system, governmental responsibilities, establishment of Jichi Medical University, participation of social organizations.We raise such suggestions as leading role of the government, precision listing underserved areas,implementing special plan, financing and payment policy, human resources for health, and regional co-ordination of medical resource.

Based on an analysis of the compensation policy and its problems of the primary medical and health institutions, this paper put forward the corresponding reform framework in Zhejiang province. It proposed to change the compensation policy of " predefining revenue and expenditure, subsidizing its gap after performance appraisal" into " a mixed system of special subsidy and pay for performance". Related policies were also described including governmental functions, special subsidies for input-based payments, classified payments for output services, precautions against financial risks, etc. This paper also suggested that we focus on dealing with the six pairs of balance, such as that between subsidy for the supply and demand sides, and that between internal market and external market.

Objective To analyze the medical service capacity of primary healthcare in Zhejiang province since the ongoing healthcare reform and put forward suggestions. Methods Key indicators of healthcare resources and medical service utilization from 2009 to 2015 reflecting the primary healthcare were identified,for a quantitative analysis in terms of the structure-process-outcome dimensions. Results In terms of structural service capacity,the average headcount growth rate of primary healthcare′s technical personnel was 5. 7% per year; the personnel competence structure kept improving; the hospital beds at primary institutions and their ratio among all were slightly decreased,with better devices and informatization. In terms of procedural service capacity,the proportion of primary institutions with contract-based services amounted to 89. 9%,with the standard contract signing rate up to 18. 8%. In terms of consequential service capacity,the average growth rate of the number of outpatient visits at primary institutions was 6. 3%. The amount and proportion of inpatients were slightly decreased,while the hospital bed utilization ratio was increased slightly. Conclusions It is necessary to further strengthen the training and introduction of primary healthcare professionals. The functional orientation of hospitals at various levels should be clarified, encouraging contract-signing of general practitioners, promote the medical insurance payment reform featuring the capitation payment at primary level,and improve the income distribution and incentive mechanism.

The "control handles"( including financing, provider payment, organization, regulation and behavior) proposed by World Bank in health policy research as the basic framework,and the nature and positioning of family doctors′ contract-based service as the precondition, we recommended the system framework of such a mechanism, comprising one contract, three regulations, five control handles and seven supporting policies. Such a framework can serve as the cornerstone for family doctors′ contract-based service experiment in Zhejiang province for the sake of hierarchical medical system.

目的:探讨浙江省近年基层医疗卫生机构公共卫生人才的现状及未来5年的需求.方法:采用分层抽样方法,对浙江省30个县(市、区)开展问卷调查.结果:30个县(市、区)494家基层医疗卫生机构在岗公共卫生人员共525人.各地区公共卫生人才招聘困难,尤其是经济欠发达地区,其应招聘而未招聘率达94.0％.未招满的主要原因是没有预防医学专业毕业生应聘.未来5年基层医疗卫生机构对公共卫生人才的需求仍在不断增长.结论:浙江省基层医疗卫生机构公共卫生人才紧缺,尤其是经济欠发达地区.针对目前“招聘难,需求大”的困境,我省急需增加应用型基层公共卫生人才的培养与输入.

运动损伤是限制高水平运动员取得更好成绩的重要因素,甚至直接导致高水平运动远离体育赛场.因此研究高水平运动员运动损伤的因素有着实际的意义.而笔者查阅文献,更多地从运动员的训练和技术因素研究的较多,但是在生理、心理、环境等因素研究的较少.因此,笔者从以上3个方面对高水平运动员运动损伤进行影响因素的研究,为高水平短跑运动员更好地避免运动损伤提供一些理论参考.

Objective To build a social evaluation index system of public hospitals,for their social evaluation to be carried out timely and provide the theory basis for governance practices.Methods Comprehensive literature analysis method,focus group discussion and individual in-depth interviews were used to collect the initial index system.The Delphi method was used to screen the evaluation index system and to calculate the index weight.Results Based on the theory of public hospitals′social evaluation model,an index system was built comprising 3 level-1 indexes,10 level-2 indexes,and 32 level-3 indexes.Conclusions In view of social systems,establishment of an evaluation index system highlighting public hospitals′social responsibility is in line with the social collaborative governance strategy,which can help with exploration and enriching the social evaluation theory and practice of public hospitals.

《巨轮壶》壶身圆润光滑,壶嘴直立向上,壶把圆润,简洁有力,壶盖平滑,壶钮凸出,壶钮与壶盖形状相似,一大一小,相互呼应.壶底稳重,从腹部往下渐收,自然简洁.

目的:定量评价浙江省全民基本医疗保险受益与补偿及均等化水平,探讨其均等化问题及改进策略.方法:选取东部经济活跃和发达的浙江省为典型研究现场,采集2008-2012年该省6个不同经济类型市(县)所在统筹地区城乡基本医疗保险住院受益及补偿的数据资料,运用平均系数、差异系数、泰尔指数和基尼系数法,综合测评其均等化程度及趋势.结果:近5年来,各统筹地区间基本医保间、基本医保内及总体住院受益与补偿水平及均等化程度均呈现不断优化提高的发展态势,但实际住院补偿比及均次住院补偿费用尚未达到底线均等水平.2012年基本医保间均次住院补偿费用差异对总体差异的贡献率为84.999％.结论:实现全民享有均等化发展的实际补偿待遇应是当前城乡基本医保统筹发展的主要观测点.相比基本医保内各统筹地区间实际补偿待遇差异的逐年减小,基本医保的不均等实际待遇的差距仍然较大.建议该省深入探究全民基本医保筹资均等化现状及预测发展趋势,为其实际补偿待遇均等化提供基础性保障条件.

以系统动力学原理为基础,利用系统动力学软件Vensim构建了环滇池截污干渠系统动力学模型(SD模型),模拟了溢流污染的产生-排放-传输全过程.通过模拟6种不同控制方案下的溢流水量及溢流水中COD随时间的变化,对比各方案的优劣性,最终可为滇池流域合流制溢流污染控制提供技术参考.