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中国新药与临床杂志 2011年第3期30卷 172-175页

作者：白玉李伟尹红章国家食品药品监督管理局药品审评中心北京100038 中国食品药品检定研究院国家药物安全评价监测中心北京100176

随着生物技术的不断发展,有越来越多的基因治疗药物申请进行临床试验。尽管总的发展趋势令人充满期待,但这类产品在技术、伦理道德以及安全性等方面仍然存在许多问题。本文综述了基因治疗药物的研发和监管现状,探讨我国在基因治疗药物... 详细信息

随着生物技术的不断发展,有越来越多的基因治疗药物申请进行临床试验。尽管总的发展趋势令人充满期待,但这类产品在技术、伦理道德以及安全性等方面仍然存在许多问题。本文综述了基因治疗药物的研发和监管现状,探讨我国在基因治疗药物注册审批和监管中还有待解决的问题。

关键词：基因疗法生物技术开发组织状况研究

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美国食品和药物管理局质量量度管理的简介及启示

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中国新药与临床杂志 2016年第4期35卷 260-263页

作者：杨依晗赵燕君高惠君上海市食品药品安全研究中心上海200233

美国食品和药物管理局《质量量度要求指南(草案)》的发布,预示着美国基于现场检查发现问题的监管模式即将发生转变。本文对质量量度的概念及发展、目标和主要内容进行简介,从质量量度及指南所体现的监管理念方面提出对完善我国药品监管... 详细信息

美国食品和药物管理局《质量量度要求指南(草案)》的发布,预示着美国基于现场检查发现问题的监管模式即将发生转变。本文对质量量度的概念及发展、目标和主要内容进行简介,从质量量度及指南所体现的监管理念方面提出对完善我国药品监管的启示。

关键词：美国食品和药物管理局质量控制组织状况研究药品生产质量

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护理组织公正、组织信任与护士留职意愿的关系研究

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中华护理杂志 2014年第5期49卷 518-521页

作者：王黎王维郭红艳谢红北京大学护理学院北京市100191 北京中健医院投资管理有限公司护理部

目的探讨组织公正、组织信任对护士留职意愿的影响,并建立三者的关系模型。方法采用组织公正量表、组织信任量表和护士留职意愿量表对北京市3所三级医院的298名注册护士进行调查。结果组织公正和组织信任均可直接正性影响护士留职意愿,... 详细信息

目的探讨组织公正、组织信任对护士留职意愿的影响,并建立三者的关系模型。方法采用组织公正量表、组织信任量表和护士留职意愿量表对北京市3所三级医院的298名注册护士进行调查。结果组织公正和组织信任均可直接正性影响护士留职意愿,组织公正还可通过组织信任的中介作用间接影响留职意愿。结论医院和护理部应共同采取有效措施增强护士组织公正感,通过提高护士对组织的信任增强其留职意愿。

关键词：护士组织状况研究留职意愿

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The costs of hospital services: a case study of Evangelical Lutheran Church hospitals in Tanzania

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HEALTH POLICY AND PLANNING 1998年第4期13卷 397-407页

作者： Flessa, S Univ Erlangen Nurnberg Sch Management D-90020 Nurnberg Germany

The health care systems of many developing countries are facing a severe crisis. Problems of financing services leads to high patient fees which make institutions of Western health care unaffordable for the majority of the rural poor. The conflict between sustainability and affordability of the official health care system challenges both local decision-makers and health management consultants. Decisions must be made soon so that the existing health care systems can survive. However, these decisions must be based on sound data, especially on the costs of health care services. The existing accounting systems of most hospitals in developing countries do not provide decision-makers with these data. Costs are generally underestimated. The leadership of the 16 hospitals of the Evangelical Lutheran Church in Tanzania is currently analyzing how the existing health care services should be restructured. Therefore, reliable estimates of the costs of hospitals services are required. A survey on 'Costing of health services of the Evang. Luth. Church in Tanzania' was prepared, which summarizes the results of seven months of field investigations in Lutheran hospitals. The major findings are that the costs of providing adequate services are much higher than expected. The most important factors determining these costs are the administrative efficiency of the hospital and the scope of services offered. The paper closes with some recommendations on how to improve the services in order to make them both affordable for the rural poor and financially sustainable for the Church. It is concluded that even the best improvement of technical efficiency will not safeguard the survival of the hospital-based health care services of the Lutheran Church in Tanzania. These findings call for a reallocation of health care resources to lower levels of the health care pyramid.

关键词：基督教费用分配发展中国家/经济学效率组织设备和供应医院/经济学卫生政策卫生服务研究/方法医院费用/统计学和数值数据医院宗教/经济学医院宗教/组织和管理组织状况研究坦桑尼亚

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Successful contracting of prevention services: fighting malnutrition in Senegal and Madagascar

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HEALTH POLICY AND PLANNING 1999年第4期14卷 382-389页

作者： Marek, T Diallo, I Ndiaye, B Rakotosalama, J World Bank Resident Mission Senegal Washington DC 20433 USA

There are very few documented large-scale successes in nutrition in Africa, and virtually no consideration of contracting for preventive services. This paper describes two successful large-scale community nutrition projects in Africa as examples of what can be done in prevention using the contracting approach in rural as well as urban areas. The two case-studies are the Secaline project in Madagascar, and the Community Nutrition Project in Senegal. The article explains what is meant by 'success' in the context of these two projects, how these results were achieved, and how certain bottlenecks were avoided. Both projects are very similar in the type of service they provide, and in combining private administration with public finance. The article illustrates that contracting out is a feasible option to be seriously considered for organizing certain prevention programmes on a large scale. There are strong indications from these projects of success in terms of reducing malnutrition, replicability and scale, and community involvement. When choosing that option, a government can tap available private local human resources through contracting out, rather than delivering those services by the public sector. However, as was done in both projects studied, consideration needs to be given to using a contract management unit for execution and monitoring, which costs 13-17% of the total project's budget. Rigorous assessments of the cost-effectiveness of contracted services are not available, but improved health outcomes, targeting of the poor, and basic cost data suggest that the programmes may well be relatively cost-effective. Although the contracting approach is not presented as the panacea to solve the malnutrition problem faced by Africa, it can certainly provide an alternative in many countries to increase coverage and quality of services.

关键词：马达加斯加营养障碍/预防和控制营养状况组织状况研究结果评价(卫生保健) 外购服务/组织和管理预防卫生服务/组织和管理塞内加尔儿童学龄前女(雌)性人类婴儿婴儿新生

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Health sector development: from aid coordination to resource management

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HEALTH POLICY AND PLANNING 1999年第3期14卷 207-218页

作者： Walt, G Pavignani, E Gilson, L Buse, K Univ London London Sch Hyg & Trop Med Hlth Policy Unit London WC1E 7HT England Ctr Hlth Policy Johannesburg South Africa

Aid coordination has assumed a prominent place on health policy agendas. This paper synthesises the findings of research undertaken to explore the changing practices of aid coordination across a number of countries. It begins by reviewing the key issues giving rise to increased attention to aid coordination in the health sector. The second section describes, assesses and compares the strengths and weaknesses of the dominant mechanisms or instruments which were found to be employed to coordinate health sector aid in the case studies. From this analysis, four factors become clear. First, in many countries, coordination mechanisms have been introduced as a part of an incremental process of trying out different approaches - there is no one model that stands out at any one time. Secondly, some instruments function largely for consultation, predominantly coordinating inputs, while others are more directive and operational, and are used to manage inputs, processes and outputs. Third, many of the mechanisms have not excelled, although, fourth, it is difficult to judge the effectiveness or impact of aid coordination. It is therefore argued that concern with the effectiveness of aid coordination arrangements must give way to a broader analysis of the processes, outputs and outcomes governing the use of both external and domestic resources, focusing on institutional characteristics, the distribution and nature of influence among the actors, and the interests which they pursue through the aid regime. These factors varied considerably across the countries indicating that aid management is context dependent and subject to continuing changes. Finally, the paper looks at the findings in the light of the introduction of sector-wide approaches.

关键词：预算发展中国家效率组织财务管理政府卫生保健公平提供/经济学卫生保健公平提供/组织和管理卫生保健改革卫生保健部门/组织和管理卫生政策卫生服务研究国际合作组织状况研究

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Reengineering and infection control programs: Commentary and a case study

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AMERICAN JOURNAL OF INFECTION CONTROL 2000年第1期28卷 44-50页

作者： Jackson, M Massanari, RM Univ Calif San Diego Med Ctr Dept Nursing Res & Educ San Diego CA 92103 USA

Transformation of the health care system has been an ongoing process for generations, but many changes in the past 2 decades have focused on reducing costs in concert with rapidly changing technologies and demands for high quality care. Many cost-containment efforts in the 1990s are characterized by attempts to apply the business model for "reengineering the corporation" to health care systems. This commentary reviews principles of reengineering and how strategies to reduce costs through market forces, competition, and downsizing can result in substantial problems for bureaucratic organizations unaccustomed to rapid change and innovation. A case study drawn from experiences of a large metropolitan academic health care system is presented, with specific focus on lessons that will be helpful to infection control professionals (ICPs) confronted with similar situations.

关键词：医学科学研究中心/组织和管理费用控制经济竞争卫生保健部门/组织和管理医院改组/组织和管理感染控制/组织和管理美国中西部组织状况研究组织改革结果与过程评价(卫生保健)/组织和管理人员减少/组织和管理政治人类

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Determinants of patient choice of medical provider: a case study in rural China

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HEALTH POLICY AND PLANNING 1998年第3期13卷 311-322页

作者： Yip, WC Wang, H Liu, YL Harvard Univ Sch Publ Hlth Boston MA 02115 USA Beijing Med Univ Training Ctr Hlth Management Beijing 100083 Peoples R China

This study examines the factors that influence patient choice of medical provider in the three-tier health care system in rural China: village health posts, township health centres, and county (and higher level) hospitals. The model is estimated using a multinomial legit approach applied to a sample of 1877 cases of outpatient treatment from a household survey in Shunyi county of Beijing in 1993. This represents the first effort to identify and quantify the impact of individual factors on patient choice of provider in China. The results show that relative to self-pay patients, Government and Labour Health Insurance beneficiaries are more likely to use county hospitals, while patients covered by the rural Cooperative Medical System (CMS) are more likely to use village-level facilities. In addition, high-income patients are more likely to visit county hospitals than low-income patients. The results also reveal that disease patterns have a significant impact on patient choice of provider, implying that the ongoing process of health transition will lead people to use the higher quality services offered at the county hospitals. We discuss the implications of the results for organizing health care finance and delivery in rural China to achieve efficiency and equity.

关键词：中国选择行为社区卫生中心/利用卫生保健调查卫生政策健康状况医院社区/利用收入保险健康组织状况研究病人接受卫生保健的程度/统计学和数值数据乡村卫生服务/分类乡村卫生服务/利用农村人口社会经济因素人类

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The development of a quality information system:: a case study of Mexico

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HEALTH POLICY AND PLANNING 1998年第4期13卷 446-458页

作者： Durán-Arenas, L Rivero, CC Canton, SF Rodríguez, RS Franco, F Luna, RW Catino, J Ctr Invest Sistemas Salud Hlth Syst Org Natl Publ Hlth Inst Cuernavaca 62508 Morelos Mexico Ctr Strateg Dev Social Secur Hlth Econ Div Mexico City DF Mexico Secretariate Hlth Qual & Technol Assessment Div Mexico City DF Mexico Mexico Gen Hosp Clin Epidemiol Unit Secretariate Hlth Mexico City DF Mexico Secretariate Hlth Div Stat Mexico City DF Mexico Natl Inst Publ Hlth Mexico City DF Mexico

One of the primary obstacles in the implementation of continuous quality improvement (CQI) programmes in developing countries is the lack of timely and appropriate information for decentralized decision-making. The integrated quality information system (QIS) described herein demonstrates Mexico's unique effort to package four separate, yet mutally reinforcing, tools for the generation and use of quality-related information at all levels of the Mexican national health care system. The QIS is one element of the continuous quality improvement programme administered by the Secretariate of Health in Mexico. Mexico's QIS was designed to be flexible and capable of adapting to local needs, while at the same time allowing for the standarization of health care quality assurance indicators, and subsequent ability to measure and compare the quality performance of health facilities nationwide. The flexibility of the system extends to permit the optimal use of available data by health care managers at all levels of the health care system, as well as the generation of new information in important areas often neglected in more traditional information systems. Mexico's QIS consists of four integrated components: 1) a set of client and provider surveys, to assess specific issues in the quality of health services delivered;2) client and provider national satisfaction surveys;3) a sentinel health events strategy;and 4) a national Comparative Performance Evaluation System, for use by the Secretariate of Health for the quality assessment of state and provincial health care services (internal benchmarking). The QIS represents another step in Mexico's ongoing effort to use data for effective decision-making in the planning, monitoring and evaluation of services delivered by the national health care system. The design and application of Mexico's QIS provides a model for decentralized decision-making that could prove useful for developing countries, where the effective use of quality indicat

关键词：规范数据收集发展中国家评价研究管理信息系统墨西哥组织状况研究公共卫生管理/标准质量指标卫生保健全面质量管理

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The changing landscape of health care financing and delivery: How are rural communities and providers responding?

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MILBANK QUARTERLY 1999年第4期77卷 485-+页

作者： Mueller, KJ Coburn, A Cordes, S Univ Nebraska Med Ctr Nebraska Med Ctr 984350 Coll Med Omaha NE 68198 USA Univ So Maine Portland ME 04103 USA Univ Washington Seattle WA 98195 USA Univ N Dakota Grand Forks ND 58201 USA Univ Missouri Columbia MO 65211 USA US Dept Hlth & Human Serv Washington DC 20201 USA

Rural communities have not kept pace with the recent dramatic changes in health care financing and organization. However, the Medicare provisions in the Balanced Budget Act of 1997 will require rural providers to participate in the new systems. Case studies revealed the degree of readiness for change in six rural communities and charted their progress along a continuum, as reflected in three sets of activities: the development of networking;the creation of new strategies for managing patient care;and the adoption of new methods for contracting with health insurers. Some communities had constructed highly integrated systems, whereas others were just beginning to change their billing practices;a few were signing contracts fbr capitated fare, in contrast to those that were resisting discounts in current fee structures. These six rural areas still have considerable ground to cover before their health fare organization and financing reach the levels achieved by urban communities.

关键词：社区网络/经济学社区网络/组织和管理病人医护连续性/组织和管理合同业务财务管理/组织和管理卫生保健部门卫生服务研究医院乡村/经济学医院乡村/组织和管理医院乡村/发展趋势保险健康补偿管理医疗规划/组织和管理 Medicare/组织和管理明尼苏达纽约俄克拉何马组织状况研究组织改革乡村卫生服务/经济学乡村卫生服务/组织和管理乡村卫生服务/发展趋势南卡罗来纳田纳西美国华盛顿老年人人类

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