Study on the influence of Beijing Medical Reform on the hospitalization expenses of medical and surgical patients in a hospital / 中华医院管理杂志

Objective:To analyze the impact of Beijing Medical Reform on inpatient costs of medical and surgical patients in a hospital, and to provide reference for the hospital to explore the path of patient cost control.Methods:Based on the data of medical and surgical inpatients′ expenses from June 2016 to December 2019 in a hospital in Beijing, breakpoint regression method was used to analyze the impact of the two reforms(namely the comprehensive reform of separation of medicine and pharmacy and the comprehensive reform of medical consumption linkage)on the level of medical and surgical inpatients′ expenses and the cost structure of drugs and consumables.Results:The two reforms controlled the rapid rise of hospitalization expenses and reduced the proportion of drugs and medical consumption. The effect of the reforms on the total cost control of internal medical patients was better than that of surgical patients.For internal medical patients, the reform of separation of medicine and pharmacy played a greater role in the proportion of medicine; For surgical patients, the two reforms had effectively reduced the proportion of consumables, and the proportion of drugs had gradually decreased.Conclusions:The two reforms have effectively controlled the growth trend of hospitalization expenses, and changed the cost structure of drugs and consumables.

Medical insurance model based on the national big data platform for medical and healthcare management / 国际生物医学工程杂志

The fundamental goal of China's medical insurance is to build a multi-level social security system covering the whole people, urban and rural planning, clear rights and responsibilities, moderate protection, and sustainable development. It is required to unify the medical insurance system, achieve fairness in medical insurance, improve the degree of protection, and increase the protection project, so as to effectively meet the needs of the basic health care services of the national diversification and to comprehensively improve the national health level. It is help to reduce the incidence of diseases, improve the quality of life, reduce the expenditure on medical expenses, and regulate the health habits of the people by emphasizing the importance of active prevention in the medical insurance sector. That is consistent with the ultimate goal of the health system reform. Active health insurance based on the national big data platform for medical and healthcare management can implement effective health interventions through various medical and economic means, helping to block risk factors before disease formation, thereby extending the individual health cycle and achieving the purpose of maintaining health. It can be foreseen that with the implementation of active medical insurance, the awareness rate of major chronic diseases will increase, and theincidence of major chronic diseases and the number of patients will gradually decrease. Therefore, the economic burden of the national medical and health system will gradually be reduced, so as to meet the growing needs of people for health care.

Policy analysis of health system reform in Luohu district of Shenzhen City / 中国卫生政策研究

Health system reform at district-level is an important but often neglected component in health system reform of China. According with the national policy-strategy guidance and the local health needs and problems within its jurisdiction,Luohu District has taken a series of effective reform measures for promoting a comprehensive reform since 2015,in which the crucial part was the establishment of"LuoHu Hospital Group". The reform in Luohu was initiated by the district-level government under the favorable policy and external conditions. The district government departments explored and innovated,and developed a featured district-level health system reform road. This experi-ence shows that district-level government should be an active actor in the local health system reform in China. The re-form in Luohu is still on the way,and more effect is yet to emerge, but the experience is of important reference for the health system reform in other regions/cities of China.

"The exploration and practice of ""County Medical Alliance"" mode in Anhui Province" / 中国卫生政策研究

This paper introduces the background, implication and construction of the county health services community (County medical alliance) model in Anhui Province under the background of new medical reform,and briefly introduces the relationship between medical insurance, enhancing the ability to upgrade and standardize services and medical treatment integration of the typical experience.It also analyses the challenges faced in the construction of medical syndicate, such as the mechanism of regional environmental restriction, compensation and assessment mechanisms which have not been established yet, and the sustainable development of information technology that has lagged behind, and put forward the policy suggestion to improve the construction of medical community, with a view to providing reference for the next work.

Analysis on equity of health resource allocation before and after new health system reform in China / 中国卫生政策研究

This paper aims at describing and comparing the changes of health resources allocation before and after new health system reform during 2006—2015 . Methods:Province-level data were used to analyze the inequities of licensed ( assistant) doctors and beds. 31 provinces were divided into 5 groups by GDP per capita and 3 groups by geographical regions. Absolute difference, relative ratio and concentration index were respectively used to compare and measure the absolute difference, relative difference and inequities in different groups before and after the new health system reform. Results:The findings of this study show the allocation of China's health resource before and after new health system reform to be as below:(1) the quantity of health resource is increasing, and the growth rate after the reform is higher than before. (2) the disparities of health resource in different economic development level areas are declining, and the decrease is faster after the reform. (3) the disparity of beds in different regions is decreasing, but the disparity of licensed (assistant) doctors in different regions is enlarging. (4) The inequities of health resource al-location in China are reduced, and the improvement is greater after the reform than before. However, the health re-source allocation is still highly inequitable to geographical areas. Discussion:(1) the policies of health resource allo-cation implementation after the reform needs improvement. ( 2 ) The amount of health resource still needs to be in-creased in certain areas, especially need to strengthen the training of high-qualified health personnel. (3) When al-locating health resources, government should focus on the impact of both population and geographical size factors.

Ideas and discussions on the reform of China's health system / 中华医院管理杂志

This paper introduced overseas experiences and theories of health systems in view of the ongoing medical and health system reform in China.It proposed the super health ministry reform,justified its necessity,and clarified key issues of such a reform,in addition to discussing how to improve the system of macro-health.

Practice and exploration of the health reform in Wuhu city / 中华医院管理杂志

Wuhu City has been exploring,since 2007,an innovative health and medical system featuring both the reform of public hospitals and that of the primary care system.This reform aims at strengthening the public health service system,improving the basic medical service system,speeding up the construction of the medical security system,and improving the drug supply system.It is characteristic of a core,two wings,and four-wheel drive,which tells the essence of Wuhu' s reform practices and outcomes.

Progress, roadblocks and challenge for China's medical and health system reform / 中华医院管理杂志

The author earmarked institutional defects as the key to China's medical and health system reform during the economic reform.Main progress and fruits of this reform during the past three years are listed as follows:theory and system innovation,initial establishment of the primary healthcare security system of nationwide coverage,establishment and implementation of the essential drug system,establishment and perfection of the primary healthcare system,equity of primary public health service,and general startup of public hospitals reform.In addition,the author identified such reform roadblocks and challenges as growing conflicts between the demand and supply of healthcare services,resistance for furthering the system reform,conflicts in drug production and circulation,lack of top-tier design for public hospital reform,and lack of systematic planning for talent development.

Medicina complementar e alternativa na rede básica de serviços de saúde: uma aproximação qualitativa / Alternative and complementary medicine in the basic health system network in Brazil: a qualitative approach

O artigo focaliza as representações sociais de profissionais da área da saúde sobre a introdução de práticas médicas complementares e alternativas na rede básica do município de Campinas (SP). A partir de uma perspectiva metodológica essencialmente qualitativa, o artigo analisa as condições, os problemas e os obstáculos na implementação dessas práticas nos serviços de saúde. O sucesso desta inclusão foi encontrado em quatro razões fundamentais: a disposição da clientela, que apoia e solicita este tipo de serviço; a visão de saúde dos médicos sanitaristas, que mostram uma abertura para este tipo de projeto; o amplo apoio proveniente de profissionais de saúde não médicos, que pretendem valorizar e ampliar a sua prática; e, finalmente, a própria perspectiva das medicinas alternativas e complementares, que se encontra em plena sintonia com a ênfase na saúde proposta pelo Sistema Único de Saúde (SUS). Apesar do sucesso na implantação dessas práticas na rede básica, dois aspectos negativos foram detectados: o planejamento insuficiente e uma visão simplificadora que converte as racionalidades alternativas em meras técnicas que seguem os mesmos princípios mecanicistas da medicina alopática e o mesmo entendimento reificado de doença.

This article focuses on the social representations of health professionals about the introduction of complementary and alternative medical practices in the public health service network in Campinas city (SP, Brazil). Based in an essentially qualitative methodological perspective, the article analyses the general conditions, the problems and the obstacles related to the implementation of such practices. The success of this inclusion was found in four main reasons: the clientele disposition which gives support and demands this kind of service; the health vision of the sanitarian doctors, which is open to such project; the wide support given by the non-medical health professions, which intend to add value and amplify their practice and, finally, the own perspective of the alternative and complementary medicines, which agree with the Unified Health System (SUS) proposals. Despite the success in the implementation of such practices in the health basic system, two negative aspects were detected: the insufficient planning and the simplified vision which converts such rationalities in mere techniques, which follow the same mechanistic principles of the allophatic medicine and the same reified understanding of disease.

The reality of health care and clinical medical education reform / 中华医学教育探索杂志

Medical clinical education is really the beginning of clinical work,and it should be reformed accordingly based on actual changes in health care.This article discusses that the clinical medical education should be reformed to face serious medical problems.

Estrategias de reforma y protección social en salud en México, segunda parte: efectos sobre equidad, eficiencia, cobertura y condiciones de salud / Health system reform strategies and health social protection in Mexico, part two: effects on equity, efficiency, accessibility and healt conditions

Objetivo: Identificar los efectos de las reformas en servicios de salud sobre indicadores de condiciones de salud de la población, así como sobre indicadores de equidad, eficiencia y cobertura en el desempeño de los sistemas de salud. Material y métodos: Se diseño una investigación evaluativa basada en el método “rapid assesment”. El universo de estudio fue el sistema de salud para no asegurados en México y la población de estudio se delimitó a seis estados seleccionados bajo diferentes criterios de factibilidad técnica, política y financiera: baja California Sur, Tabasco, Jalisco, Oaxaca, Hidalgo y Colima. Para los datos primarios se realizaron entrevistas a profundidad con informantes clave de los estados participantes; para los datos secundarios se utilizaron estadísticas oficiales y los resultados del proyecto macro sobre reformas, políticas de salud, equidad, financiamiento y gobernanza en México, 1999-2006. El procesamiento y análisis de datos se realizó con 3 paquetes de software: ATLAS Ti, STATA y POLICY MAKER. Resultados/Conclusiones. A partir de las reformas se han registrado importantes incrementos en los montos del financiamiento en salud y cambios de mayor efectividad en los mecanismos de coordinación entre los niveles de gobierno en salud en la mayoría de los estados del país; estos cambios también han coincidido con ganancia positiva en algunos indicadores sociales y particularmente con mejora en los niveles de la mortalidad infantil, mortalidad materna y morbilidad por enfermedades crónicas e infecciosas; existen evidencias de mejoría en indicadores del desempeño del sistema de salud que coinciden con la implementación de los cambios señalados.

Objective: To identify health system reform effects on populations’ health conditions indicators, and on equity, efficiency, coverage and health system performance. Methods and data sources: A design of evaluative research based on rapid assessment was developed. The research object it was the health system for uninsured population in Mexico, focusing on six States selected considering technical, political and financial feasibility: Baja California Sur, Jalisco, Tabasco, Oaxaca, Hidalgo y Colima. For primary data gathering structured interviews with key informants of selected States were done; for secondary data official statistics and research results of the macro project on health system reform, health policy, equity, financing and health governance in Mexico were used. Data processing was carried out using three software packages, Atlas-Ti and Policy Maker for qualitative information, and Stata for quantitative data. Results / Conclusions: Health system reform has produced an important increase in health financing amounts and changes in major effective coordination mechanisms among government levels in selected states. These changes have also coincided with positive gains in some social indicators and improvements in infant mortality, maternal mortality and morbidity of infectious and chronic diseases. There are evidences of improvement of health system performance which are coincident with implementation of the changes.

Diagnóstico evaluativo para el fortalecimiento de estrategias de intervención en salud mental en Argentina / Diagnostic evaluation for the strengthening of strategies of intervention in mental health in Argentina

El estudio muestra los principales hallazgos de un diagnóstico evaluativo sobre políticas, planes y servicios que brindan cuidados en salud mental en Argentina. Con un diseño plural cuali-cuantitativo y un carácter multicéntrico y colaborativo, su desarrollo incorporó diversas contribuciones teórico-metodológicas, a partir del relevamiento de información de diferentes fuentes primarias y secundarias. Se trabajó sobre seis áreas geográficas que ya contaban con legislación para salud mental en 2007: Río Negro, Córdoba, EntreRíos, San Juan, Santa Fe y Ciudad Autónoma de Buenos Aires. Su objetivo fue producir conocimientos que contribuyeran a estimular el debate y a priorizar la salud mental en la agenda de las políticas sanitarias. Tomando por referencia los principios que impulsan los procesos internacionales de reforma de la atención en salud mental, se señala que Argentina aún carece de una ley nacional de salud mental. La expansión de los servicios de salud mental articulados a la atención primaria muestra una dirección ya consistente y asumida en las políticas sanitarias. A excepción de Río Negro, en las demás jurisdicciones se evidencia un modelo dual que superpone la atención hospitalaria centrada en la enfermedad mental junto a incipientes estrategias y dispositivos alternativos insertos en la vida comunitaria. La escasa información epidemiológica compone un cuadro disperso que no permite conocer problemáticas prevalentes ni priorizar grupos poblacionales vulnerables

The study shows the main findings from a diagnostic evaluation up on strategies, planning and services formental health care in Argentina. With an extensive qualitative and quantitative design and a multicentric and collaborative character, the study has incorporated several theoretical and methodological contributions and information primary and secondary sources. It has worked in five areas that had legislation for mental health in 2007: Río Negro, Córdoba, Entre Ríos, San Juan, Santa Feand Ciudad Autónoma de Buenos Aires. It intended to produce know ledge to stimulate the debate and give a priority status to mental health in the agenda of health policies. Taking into account, as a reference, the principles that gave impulse to the international processes to reform the attention in mental health, it is important to point out that Argentina do not have, yet, a national law for mental health. The expansion of services in mental health, articulated to primary care, shows a consistent direction assumed by the sanitary policies. Exception made to Río Negro, in the remaining jurisdictions there is a dual model that overlaps the hospital centered care in mental health, together with incipient strategies and alternative devices, inserted in the communitarian life. The very little epidemiological information created an elusive panorama that makes impossible to reach the core of the main problems, or give a priority attendance to the most vulnerable population

Clinical medical research under guidance of public welfare / 中华医学科研管理杂志

In this paper the causes of deficiency of public welfare were analyzed in medical research,and some strategies were proposed to enhance the public welfare of public health care services according to the cardinal principles of new healthcare reform package in 2009.These were benefit to maintain the public welfare of public medical and health care services,and to reach the goal of medical research served as the clinic and the patients.

Pondering over Chinese Medical and Health System Reform / 中国药房

OBJECTIVE: To discuss the goal and the measures that should be taken in the reform of Chinese medical and health system. METHODS: The changes of Chinese medical and health system were briefly reviewed and the current problems in which were analyzed, then the goals and the corresponding measures in the future medical and health system reform were put forward. RESULTS & CONCLUSION: The reform of Chinese medical and health system should in line with medical insurance reform and drug circulation system reform. The central financial expenditure system should be reformed by carrying out the principle of “common benefits” and eliminating differential treatment between city and countryside or among areas so as to implement equalization in medical and health service. The concerned departments should improve resource management system and optimize medical resources allocation. The government should strengthen the monitoring on medical and health service industry to facilitate its healthy development.

Teias e tramas: relações público-privadas no setor saúde brasileiro dos anos 90

O trabalho busca identificar as principais mudanças ocorridas no setor privado de saúde no Brasil, dentro da conjuntura de reformas do modelo econômico e do Estado, iniciada, no país, nos anos 90. Seu objetivo foi contribuir para a rediscussão das relações público-privadas, ainda permeadas por uma contradição, de caráter geral, entre o público e o privado. [...] A oferta foi analisada dentro dos mercados definidos no estudo: seguros e serviços. Quanto aos seguros, o acirramento da competição, num ambiente mais regulado pelo Estado, aponta tendências a maior concentração, que são discutidas quanto a seus determinantes tecnológicos, competitivos e financeiros, ressaltando-se as principais vantagens e desvantagens de cada modalidade. A análise dos serviços mostra indícios de transformações importantes quanto à formação de cadeias de estabelecimentos hospitalares, a reestruturação produtiva dos hospitais, através de um intenso processo de terceirização e as transformações capitalistas em alguns sub-mercados, como os laboratórios de análises clínicas, que se concentraram e internacionalizaram. O mercado de serviços lucrativos passa a atrair fundos de investimento tanto internacionais quanto nacionais. A integração com os seguros também é notada em váriosexemplos. A despeito das mudanças terem apontado para uma maior heterogeneidade dentro do setor privado e para a consolidação de um segmento de grande capital, a conjuntura geral recessiva é um elemento de incerteza acerca de seus rumos

During the 90’s occurred, in Brazil, an extensive reform process that included a state reform and a health system reform. A new health system – SUS – emerged from the Brazilian Constitution approved in 1988 and, specially, from the laws and the operational rules fixed during the 90’s. Together with this new shape of the state’s health system it took place a new relationship pattern between the public and private health providers. This thesis focus on the dynamics of those heterogeneous health providers, taking in account not only the complex structure of the supply but also the moving of the demand for health care services. Our analysis aimed to integrate both sides of this health system dynamics seeking to identify trends for the near future

Vigorously promoting reform of the medical health system and accelerating development of community health services / 中华医院管理杂志

A nationwide pilot project concerning community health sendees, the major part and chief link of the reform in the urban medical health system, has basically come to an end. The author expounds against the background of reform in the health system in China the motives and orientation of reform in the medical health system and the current situation of and problems in the development of community health services. It is pointed out that advancing community health services entails all of the following:①genuinely transforming concepts and seeking unity of thinking; ②adopting the mechanism of competition and enhancing the sense of innovation; ③persisting in keeping abreast of the times and laying emphasis on reform and development;④accelerating the readjustment of resources and optimizing resource allocation; ⑤ceating a sound environment and seeking common development; ⑥giving priority to the improvement of quality and avoiding superficial transformation.