社区卫生服务中心与医院手术费用的比较研究

目的:比较社区卫生服务中心及各级医院常见手术费用;社区卫生服务中心手术是否便捷、低耗,有无保留的必要。方法:调研南京市社区卫生服务中心及各级医院常见手术的单病种费用,社区卫生服务中心与各级医院的费用做统计分析比较。结果:社区卫生服务中心单病种手术平均住院费用明显低于与各级医院。结论:从经济学的角度分析,各级医院手术费用差别很大,在规范和安全的前提下,社区卫生服务中心保留基本的手术功能是符合社区居民需求和社区卫生服务自身发展需要的。     

The duty to care and the need to split

This paper arises out of psychoanalytically oriented consultancy to teams of staff in the helping professions where there is a statutory 'duty to care'. It takes as its premise the seemingly paradoxical hypothesis that workers may need to split off part of their emotional experience in order to preserve their own mental health and provide reliable services to their clients. I argue that while a professional 'duty to care' requires us to be emotionally 'in touch', the demands of our clients together with the demands of the institutional response to the 'duty to care' cause us to split off parts of our awareness. I also argue that provided the splitting does not become extreme we are doing no more or less than the rest of society. In other words, there is a degree of 'normal splitting' which numbs our awareness of danger and destructiveness and seeks to protect us from too much anxiety and pain. Yet if professional workers are charged with the responsibility of assessing risk and acting accordingly for the protection of all concerned they need ways of being 'in touch' (re-integrating the splits) for some or enough of the time. Finally, I will describe ways of being 'in touch', illustrating the difficulty and the pain of re-integrating the splits and some of the insights that can arise out of this work with examples from my consultancy work.     

Competition and The Operational Performance of Hospitals: The Role of Hospital Objectives

We examine the effect of a hospital's objective (i.e., non‐profit vs. for‐profit) in hospital markets for elective care. Using game‐theoretic analysis and queueing models to capture the operational performance of hospitals, we compare the equilibrium behavior of three market settings in terms of such criteria as waiting times and patient costs from waiting and hospital payments. In the first setting, a monopoly, patients are served exclusively by a single non‐profit hospital; in the second, a homogeneous duopoly, patients are served by two competing non‐profit hospitals. In our third setting, a heterogeneous duopoly, the market is served by one non‐profit hospital and one for‐profit hospital. A non‐profit hospital provides free care to patients, although they may have to wait; for‐profit hospitals charge a fee to provide care with minimal waiting. A comparison between the monopolistic and each of the duopolistic settings reveals that the introduction of competition can hamper a hospital's ability to attain economies of scale and can also increase waiting times. Moreover, the presence of a for‐profit sector may be desirable only when the hospital market is sufficiently competitive. A comparison across the duopolistic settings indicates that the choice between homogeneous and heterogeneous competition depends on the patients' willingness to wait before receiving care and the reimbursement level of the non‐profit sector. When the public funder is not financially constrained, the presence of a for‐profit sector may allow the funder to lower both the financial costs of providing coverage and the total costs to patients. Finally, our analysis suggests that the public funder should exercise caution when using policy tools that support the for‐profit sector—for example, patient subsidies—because such tools may increase patient costs in the long run; it might be preferable to raise the non‐profit sector's level of reimbursement.     

Every Minute Counts: Using Process Improvement and Performance Feedback to Improve Patient Flow in an Emergency Department

Prolonged emergency department (ED) visits are associated with a number of adverse outcomes for patients as well as lower patient satisfaction scores and increased costs. Several factors that influence the length of ED visits are out of the control of hospital employees, but some opportunities exist to improve performance. For this study, the ED department of a 150-bed hospital in the southeastern United States wanted to improve door-to-discharge time. To do so, a subprocess of door-to-discharge time was targeted, door-to-order. After analyzing the process, the team created standard orders for the 10 most common presenting conditions in the ER with preapproval, allowing nurses to submit the orders without the provider first visiting the patient. Following the process change, daily feedback was added to increase utilization of the preapproved orders. Reductions in door-to-order times and door-to-discharge were observed and patient satisfaction remained stable. Implications for future research in this area are discussed.     

中世纪英格兰医院制度论略

诺曼征服后,英格兰的医院主要是由修道院建立的。12、13世纪由于城市、贸易发展等原因,世俗人士也开始大量地建立医院,但这些医院的医务人员仍以修士或修女为多。中世纪末期,随着封建经济的衰落,这种宗教式医院也随之衰落。中世纪英格兰的医院中真正的医疗很少,主要是为病人、穷人提供生活上的照顾和心灵的"救治",但在组织和文化观念上为现代医院的发展奠定了基础。     

论公立医院的品牌经营

在加入WTO后的社会主义市场经济条件下,公立医院要解放思想,更新观念,进行医院品牌经营。从品牌的含义及对公立医院的作用,医院品牌的创建,医院品牌的经营策略,医院品牌承诺的内容等四个方面进行了论述。认为公立医院进行品牌经营是今后医疗市场激烈竞争的必然结果。     

新型农村合作医疗实施后的医疗现状浅探——对2005年度湘潭县花石镇的调查

新型农村合作医疗试点工作自2003年推行以来初见成效。但"看病难、看病贵"问题仍然困扰着中国农民。新型农村合作医疗制度本身的设计缺陷、农村三级卫生体系的不健全、乡镇卫生院的公益性严重淡化等,仍然是影响农民医疗的关键因素。     

市场经济条件下非经营性事业单位财务管理体系的构建——以公立医院财务管理为例

传统的非经营性事业单位财务管理存在许多弊端。以公立医院财务管理为例,建立市场经济条件下适应现代化非经营性事业单位发展需要的财务管理体系,必须从实施制度化管理、加强财务核算与财务监督、参与经济决策、增加管理的技术内涵等方面入手,走科学化、规范化、法制化的轨道。     

南京市某三甲医院护士流失情况的调查分析

近年来护士流失日趋严重,文章采用离职护士数据分析、电话随访的方法,分析南京市某三甲医院2006～2011年护士流失的基本情况和特点,探讨护士流失的主要原因,并提出推行护士分层绩效管理、满足年轻护士心理需求、创造更多学习晋升机会、提高职业地位等建议以解决当前护士流失现象。     

自媒体时代医院网络舆情分析及立体文化应对

在自媒体迅猛发展的背景下,网络舆情对医院形象和公众视线产生巨大的影响。在对医院网络舆情进行调查的基础上,分析了网络舆情产生的成因、特点及其对医院文化与发展的冲击和影响,提出了构建医院立体文化传播平台的相关对策思考。