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The Spanish health care system:: lessons for newly industrialized countries

HEALTH POLICY AND PLANNING 1999年第2期14卷 164-173页

作者： Rodríguez, E De Puelles, PG Jovell, AJ Cornell Univ Dept Policy Anal & Management Ithaca NY 14853 USA Catalan Hlth Serv Catalan Agcy Hlth Technol Assessment Dept Hlth & Social Secur Barcelona Spain

This article summarizes the organization, financing, and delivery of health care services in Spain, and discusses the elements that made it possible to maintain high levels of health among the population, while spending comparatively fewer resources on the health care system than most industrialized countries. The case of Spain is of particular interest for newly industrialized countries, because of the fast evolution that it has undergone in recent years. Considered, by United Nations' economic standards, a developing country until 1964, Spain became in a few years the fastest growing economy in the world after Japan. By the early 1970s the infant mortality rate was already lower than in Britain or the United States.

关键词：卫生保健提供/经济学卫生保健提供/组织和管理发达国家效率组织筹资政府卫生保健公平提供卫生经费支出卫生人力健康状况指标医院公立/组织和管理国家卫生规划/经济学国家卫生规划/组织和管理初级卫生保健/组织和管理公共卫生管理社会正义西班牙/流行病学世界卫生

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Public hospital resource allocations in El Salvador: accounting for the case mix of patients

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HEALTH POLICY AND PLANNING 1998年第3期13卷 296-310页

作者： Fiedler, JL Schmidt, RM Wight, JB Univ Richmond Richmond VA 23173 USA

National hospitals in developing countries command a disproportionate share of medical care budgets, justified on the grounds that they have a more difficult patient case mix and higher occupancy rates than decentralized district hospitals or clinics. This paper empirically tests the hypothesis by developing direct measures of the severity of patient illness, hospital case-mix and a resource intensity index for each of El Salvador's public hospitals. Based on an analysis of inpatient care staffing requirements, national hospitals are found to receive funding far in excess of what case-mix and case-load considerations would warrant. The findings suggest that significant system-wide efficiency gains can be realized by allocating hospital budgets on the bases of performance-related criteria which incorporate the case-mix approach developed here.

关键词：病床利用率/统计学和数值数据预算诊断相关患者组/分类诊断相关患者组/统计学和数值数据效率组织萨尔瓦多/流行病学卫生经费支出/统计学和数值数据卫生资源/分类卫生资源/利用卫生服务研究医院公立/经济学医院公立/组织和管理医院公立/利用年患病率人员配备和时间安排/统计学和数值数据疾病严重程度指数人类

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Knowledge for the clinician - 7. Intranets

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JOURNAL OF THE ROYAL SOCIETY OF MEDICINE 2000年第10期93卷 530-534页

作者： Wyatt, JC UCL Knowledge Management Ctr London WC1H 3EZ England

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The 'market' for medical and health information in transition: the case of the Hong Kong Hospital Authority libraries.

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Health libraries review 1996年第2期13卷 69-80页

作者： Cheng, G. Hong Kong Hospital Authority. Hong Kong

The last few years have been a period of transition not only for hospitals and their governance but also for post-graduate medical education in Hong Kong. Both trends have a direct impact on the information market place. This article starts by studying the provision of medical and health-related information in Hong Kong. The two university medical and dental libraries, together with the hospital and health sciences libraries in government hospitals and the Department of Health, house the major collections on medicine and health care. The demand for medical and health care information is increasingly felt with the takeover of 39 hospitals by the statutory Hong Kong Hospital Authority in 1991. The major problems and issues in planning for library information services are the historically uneven development of libraries, discrepancies in funding, the changes in organizational and management structure, and the competition with higher development priorities within the organization. In view of current technology and the availability of rich external resources, the adopted strategies tend towards the formation of 10 library service networks, development of integrated library information systems on the Health Authority-wide area network, and the devolution of management responsibilities. The future challenges in store for the information professional are examined.

关键词：社区网络数据库文献型财政支持香港医院公立/组织和管理信息服务/经济学信息服务/组织和管理信息服务/利用图书馆医院/经济学图书馆医院/组织和管理图书馆医院/利用图书馆调查模型组织管理专家委员会

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现代公立医院宣传管理探讨

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中国误诊学杂志 2011年第12期11卷 2895-2896页

作者：张晓萍清华大学第一附属医院北京100016

本文目的阐述医院目前在市场经济和医改环境下如何实施有效的宣传管理。根据作者多年工作经验,提出医院宣传管理必须建立、完善适应新环境的医院宣传管理体系,

关键词：医院公立/组织和管理

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Paradoxical consequences of excess in structural complexity: a study of a state children's psychiatric hospital

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Sociology of Health & Illness 1980年第3期2卷 277-292页

作者： Blau, Judith R. Department of Sociology State University of New York at Albany

Abstract This paper examines how a unique organizational structure promotes a high level of care and treatment in a large, public children's psychiatric hospital. The structure ‐ complex and interdependent ‐ is best understood in terms of three dimensions of staff relations: administration, child care, and clinical practice. Because these dimensions are independent of one another and each delineates positions for every staff member, everyone occupies several statuses simultaneously and thus has multiple role relations with nearly every other staff member. Consequences of this multiple‐matrix organization are: the importance of emergent coalitions and diffuse exchange relations for power and influence;a treatment approach that depends on professional expertise but must be legitimized in terms of lay values concerning youngsters;problems of morale and ambivalence. The complex structure engenders a high level of humane care and expert treatment, in part because multiple role relations foster a holistic view of youngsters. Copyright © 1980, Wiley Blackwell. All rights reserved

关键词：儿童住院/心理学阶层社会医院病床数 100张以下医院精神病/组织和管理医院公立/组织和管理医院州立/组织和管理纽约卫生保健质量儿童人类

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MENTAL-HEALTH WORKERS RATINGS OF THE IMPORTANCE OF THE GOALS OF A COOPERATIVE CMHC-STATE HOSPITAL SCREENING AFTERCARE PROGRAM

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JOURNAL OF COMMUNITY PSYCHOLOGY 1981年第4期9卷 355-360页

作者： LUEGER, RJ WASHBURN UNIV TOPEKA KS 66621 USA

AbstractRatings of the importance of the goals of a pilot community mental health center (CMHC)‐state psychiatric hospital cooperative program aimed at providing screening and aftercare were obtained from 214 mental health professionals. Respondents were employed at state hospitals, at CMHCs that were participating in the program, and at CMHCs that were not participating in the pilot cooperative program. Ratings of importance were found to differ across goals, between mental health workers of state hospitals and CMHCs, between participating and nonparticipating CMHCs, between professions, and as a function of distance between CMHCs and state hospitals. Implications of the findings for the evaluation of the success of a cooperative screening‐aftercare pilot program are discus

关键词：出院后医疗/组织和管理医务工作者的态度社区精神卫生中心/组织和管理目的医院公立/组织和管理医院州立/组织和管理组织目标试点项目美国人类

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Has DRG payment influenced the technical efficiency and productivity of diagnostic technologies in Portuguese public hospitals? An empirical analysis using parametric and non-parametric methods

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Health Care Management Science 1999年第2期2卷 107-116页

作者： Dismuke, Clara Elizabeth Sena, Vania Department of Economics Universidade do Minho P-4709 Braga Portugal Department of Economics and Related Studies University of York United Kingdom

The use of Diagnosis Related Groups (DRG) as a mechanism for hospital financing is a currently debated topic in Portugal. The DRG system was scheduled to be initiated by the Health Ministry of Portugal on January 1, 1990 as an instrument for the allocation of public hospital budgets funded by the National Health Service (NHS), and as a method of payment for other third party payers (e.g., Public Employees (ADSE), private insurers, etc.). Based on experience from other countries such as the United States, it was expected that implementation of this system would result in more efficient hospital resource utilisation and a more equitable distribution of hospital budgets. However, in order to minimise the potentially adverse financial impact on hospitals, the Portuguese Health Ministry decided to gradually phase in the use of the DRG system for budget allocation by using blended hospital-specific and national DRG case-mix rates. Since implementation in 1990, the percentage of each hospital's budget based on hospital specific costs was to decrease, while the percentage based on DRG case-mix was to increase. This was scheduled to continue until 1995 when the plan called for allocating yearly budgets on a 50% national and 50% hospital-specific cost basis. While all other non-NHS third party payers are currently paying based on DRGs, the adoption of DRG case-mix as a National Health Service budget setting tool has been slower than anticipated. There is now some argument in both the political and academic communities as to the appropriateness of DRGs as a budget setting criterion as well as to their impact on hospital efficiency in Portugal. This paper uses a two-stage procedure to assess the impact of actual DRG payment on the productivity (through its components, i.e., technological change and technical efficiency change) of diagnostic technology in Portuguese hospitals during the years 1992-1994, using both parametric and non-parametric frontier models. We find evidence t

关键词：诊断相关患者组/经济学诊断检查服务/经济学诊断检查服务/利用效率组织/统计学和数值数据卫生服务研究医院公立/经济学医院公立/组织和管理医院公立/利用保险健康补偿模型统计学葡萄牙回归分析公费医疗利用情况审核

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Processes of persuasion: Social interests and total quality in a UK hospital trust

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HEALTH CARE ANALYSIS 1995年第4期3卷 283-289页

作者： Jackson, P UNIV TEESSIDE SCH HUMAN STUDIESBOROUGH RDMIDDLESBROUGH TS1 3BACLEVELANDENGLAND

This paper examines some of the processes which have contributed to the development of a 'total quality' (TQ) approach within British health care. The paper challenges the idea that TQ is part of a redistribution of power within the NHS. Rather it is argued that through the elaboration of consumer-led market identities TQ misrepresents the interests of management and constructs a version of the self which obscures new forms of managerial control. TQ constrains alternative forms of social organisation, local knowledge and the social interests invested in them. An example of a competing set of assumptions is discussed. It is suggested that clinical groups-who are primarily motivated by the principles of professional, collegiate control-seek to free themselves from the constraints of TQ. Thus clinical discourse appropriates a professionally led version of the market and protects the traditional autonomy of professionals whilst seeming to render their interests synergistic with those of management. This casts 'quality', and perhaps even the 'market', as conceptual sites upon which different groups strive to construct and legitimate their own interests. It is concluded that the changes explicitly associated with TQ are not as fundamental as they seem.

关键词：数据收集大不列颠卫生服务研究医院医生关系医院公立/组织和管理医院公立/标准组织文化权力(心理学) 职业自主权公费医疗/组织和管理公费医疗/标准全面质量管理/组织和管理人类

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Developing multidisciplinary library services in trust hospitals: a case study at the City Hospitals Sunderland NHS Trust.

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Health libraries review 1996年第4期13卷 203-212页

作者： Childs, S.M. Centre of Health Studies University of Durham New Elvet United Kingdom

The paper describes an example of good practice in the establishment of multidisciplinary library services at a Trust hospital. In 1995, City Hospitals Sunderland NHS Trust commissioned a survey to determine their needs for library services for all staff. The results of the survey and the recommendations are described. The Trust's further actions are briefly noted. This case study is set into the wider context of the need for well-resourced library and information services within the NHS. The constraints under which such developments operate are listed.

关键词：聘任鉴定费用效益分析数据收集英格兰医院公立/组织和管理医院市区/组织和管理图书馆医学/经济学图书馆医学/组织和管理图书馆医学/标准图书馆服务/经济学图书馆服务/组织和管理图书馆服务/标准模型组织管理国家卫生规划人类

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