Study on longitudinal integration of medical service resources considering patients' preference in tiered medical care system / 中国卫生政策研究

The hierarchical diagnosis and treatment system is an important measure for rational allocation of medical resources, promotion of equalization of basic medical services, improving the patients' disorderly medical treatment and guiding patients' hospital choice behavior. This paper defines the utility function of rational medical treatment of patients affected by multiple factors such as the personal disposable income,the age,the severity of the self-induced illness and the decision-makers' education level, and considered the outpatient price, service capacity and other factors of medical institutions. The present study constructed the incomplete information dynamic game model based on fictitious play method. It provided the quantitative analysis of the statistical data of Qinhuangdao and obtained the patients distribution in medical institution. The rationality of the model was verified by comparing the simulation with actual data,and showed the choice is more reasonable between the primary health care and general hospital. Therefore,the emphasis of optimizing the medical service resources in hierarchical diagnosis and treatment system is to establish the treatment system of integrated medical service for patients'on-demand and on-demand medi-cal services. At the same,various incentives should be used to enhance patients'enthusiasm for primary health care.

Evolutionary game of resources integration on secondary hospital and tertiary hospital in tiered medical care system / 中国卫生政策研究

The paper analyzed the decision-making process of the doctor's treatment and patient's decision-making. Then established the evolutionary game model of patient's and the secondary-tertiary hospital doctor's strate-gy. The Matlab simulation software were used to analyze the influencing factors of patient-doctor strategy-making sys-tem. We proposed the advice reducing critical patient's utility loss diagnosed in secondary hospital,improving medi-cal experience of common patient in secondary hospital,strengthening disease prevention of critical patient,and pro-moting labor division and cooperation between secondary and tertiary hospital to make result develop towards reduction the disorderly,chaotic and dislocated medical need and an integrated secondary and tertiary system.

Cognitive status and impact of tiered medical care system implementation on medical staff / 中国卫生政策研究

Objective:To understand the impact of hierarchical medical system on the medical staff at all levels of medical institutions in the pilot areas,and their cognitive status and influencing factors for hierarchical medical sys-tem,for the purpose of providing scientific reference for improving the hierarchical medical system. Methods:435 of medical staffs were selected with the help of by stratified random sampling from different levels of medical institutions from 15 pilot areas and a questionnaire survey methodology was used in this study to gather views of the medical staffs. Results:It has been revealed that after the system is implemented,there were differences in the total monthly salary,performance pay ratio,workload and the relationship between doctors and patients at different levels of medi-cal institutions. The medical staff at all levels of medical institutions had a high degree of awareness of hierarchical medical system,and the cognition rate was 81.4%. Among them,tertiary hospitals,township hospitals,community health service centers,secondary hospitals;different department categories,job titles,performance pay ratio and sal-ary changes in the medical staff have different cognition of the grading. Conclusions:To further develop the key role of medical staff in the hierarchical medical system, strengthen the attention of secondary hospitals to enhance the service capacity of primary healthcare units at the same time,reform the pay system,mobilize the enthusiasm of med-ical institutions and medical staff,and promote the development of hierarchical treatment system.

A Concept of "Transition of Care" in Japan -Focusing on Care Transition of Patients Who are Discharged from a Hospital and Treated at Another Clinic as an Outpatient- / 日本プライマリ・ケア連合学会誌

Recently in Japan, "transition of care" cases, in which patients are transferred from a medical institution that had once provided medical care to a new one and the medical care provider is therefore changed, are increasing. However, the concept of "transition of care" and "undesirable outcomes in patients accompanied by care transition" have been studied very little in Japan. The concept of "transition of care" consists of factors such as patient background (age, underlying disease, and family's caregiving ability), transfer of clinical information, and tools to transfer clinical information. In Europe and the USA, undesirable outcomes accompanied by care transition, such as "medicamentous adverse events", "clinical examination data taken during hospitalization are not confirmed", and "medical care planned for a patient is not implemented", are reported to have occurred for 19% to 50% of patients who had been discharged from hospitals and transferred to clinics. It is also necessary to understand the state of care transition in Japan and investigate countermeasures compatible with the Japanese medical care system.

Principle of multi-echelon medical care for the injured in Chinese Wenchuan earthquake / 中华创伤杂志

Objective To discuss the application value and improvement of principle of multi-echelon medical care in emergent rescue of the injured in Chinese Wenchuau earthquake. Methods The author analyzed and evaluated the medical rescue that was done at disaster site, in the front line hospital and higher level hospitals during earthquake. Results A total of 4 689 patients were treated at disaster site, including 413 patients with severe injury, of whom 3 died. Different kinds of operations including debridement were performed at disaster site, with infection incidence of open wound was nearly 80%. In the front hne hospital, 1 400 patients were treated, with 200 operations done. Of all, 110 patients with severe trauma were treated emergenfly, with an amputation rate of 3.0% and postoperative infection incidence of 66.8%. In the station hospitals, 125 patients received definite surgeries, with 1-5 surgeries per injury site. There was no postoperative cross infection, amputation or death. Conclusions The multi-echelon medical care is the basic mode for medical rescue of large number of patients in natural disaster rescue. First aid at disaster site should be performed as early as possible. Transportation is crucial for successful rescue and an improved patient grading system can help increase the efficiency of rescue. The front line hospitals should mainly provide life support, debridement and fixation of simple fracture, while the specific treatment and definite surgery should be carried out in the station hospitals.

Early Neonatal Mortality, Low Birth Weight and Related Factors in Japan

Objectives: The author conducted an ecological study to examine prefectural differences in ENMR and the related factors in Japan, using two new indicators; birth weight (BW) adjusted ENMR and expected ENMR by BW distribution. Method: Correlate analysis of data from national vital statistics and some indicators of medical care services among 47 prefectures edited by the Ministry of Health and Welfare, Japan were conducted. BW-adjusted ENMR and expected ENMR by BW, as well as other indicators, were prepared for statistical analysis. Result: Crude and BW-adjusted ENMRs were significantly correlated with ENMRs for low birth weight (LBW) and very low birth weight (VLBW) early neonates (p<0.01). The number of Obstetrics and Gynecology (OB/GYN) physicians was negatively correlated with BW adjusted ENMR. Conclusion: Crude and BW-adjusted ENMRs were affected mainly by LBW and VLBW early neonate specific ENMR, but not by the rate of LBW. The variation of ENMR among prefectures in Japan is attributable to the number of OB/GYN physicians. The present findings suggest that emphasis should be laid upon enhancement of regional perinatal care systems.

A National Sample Survey of Medical Students about Their Perception and Evaluation on Medical Study, Career Plan, and Medical Care System: Part 1. Survey Methods and Characteristics of Sample / 한국의학교육

Since the first survey done in 1983, this is the second national sample survey of medical students about their perception and evaluation on medical study, career plan, and medical care system. One out of every 10 students plus one in each class were systematically sampled from each grade year of 32 medical schools in Korea that had students from freshman to senior in November 1997. A questionnaire was developed by adding items related with recent changes in medical care environment and with viewpoint on medicine and physician as an occupation to the questionnaire used in 1983. The questionnaire was administered at each school under the supervision of designated collaborator of the same school in December 1997 through January 1998. A total of 1,386 students were sampled from a total of 11,987 medical students and 1,233 students(89.0%) filled out the questionnaire. Twelve students were excluded from the analysis because of incomplete response and the final analysis was done for 1,221 students. A few demographic characteristics of the sample were compared with those of the study population to check the representativeness of the sample and found no skew. The contents of the study were divided into three parts and the first part describes the study methods, demographic and other characteristics of the sample, students' viewpoint on medical education, and students' aptitude for medicine Male students accounted for 75.7% of the sample. The proportion of students who entered medical school right after graduating from a high school was 45.8% in Seoul and 53.4% in other than Seoul area. The students who classified their own political inclination conservative were 43.9% in Seoul and 33.0% in other than Seoul and the percentage of students with progressive inclination was higher in out of Seoul than Seoul area. The proportion of students who have a religion was 57.2%; Christian 31.0%, Catholic 15.2%, and Buddhist 9.5%. The educational level of fathers of students was far higher than the level of general population, e.g. 59.8% had college or higher education. Occupation of fathers was mainly white-collar worker; professional worker 21.2%, company employee 17.2%, government official 13.1%, manager 11.8%, and medical professional 8.7%. In the decision-making process to enter the medical school, 53.7% of the students were influenced by someone else and 62.1% of them were parents. Socio-economic factor was the most common reason for recommending medical school and it accounted 33.5% of the reasons. Medical students enjoy learning life phenomenon(47.2%) and human being(44.3%) in medical study but most disturbing factors are memory work(39.7%) and too much to study(34.1%). If students were given another chance to choose a college as a senior student in high school, 50.3% of them said that they would choose medical school. Only 6% of students have intention to change their major subject of study if they are allowed to change now. The proportion of students who consider their scholastic aptitude is compatible with medical study was 64.9% and such proportion increased with grade. The percentage of students who are going to recommend medical school to their own son in the future was 36.6% for male and 26.7% for female students and to their own daughter 33.6% and 27.7%, respectively.

The opinions of doctors about korean traditional medicine and unification of medical care system

BACKGROUND: There were a lot of problems in the health care system of Korea, which was divided into Western and Korean Traditional Medicine since 1951. In 1976 WHO published program of The promotion and development of traditional medicine. In 1977, Korean Medical Association(KMA) asked unification of health care system to government. But there was no progress because there were the lacks of mutual respect and understanding be-tween doctors of Western and Korean Traditional Medicine. As one health care group competed with the other, so KMA proposed the unification of health system again in 1997. The objectives of this research are to analyze attitude and opinions of western medical doctors on Korean Traditional Medicine and to analyze the opinions on the unification of medical care system in Korea. METHODS: A list of western medical doctor in Seoul and Incheon was obtained from Korean Medical Association. We sampled 937 doctors by stratified random sampling method. We sent them a postal questionnaire with a prepaid return envelope two times during March and April 1997. Of the 937 questionnaire, 266 replies were received. We analyzed the preference score related referral, Korean Traditional Medicine education and unification of medical care system We analyzed the data by Chisquare test, t-test, ANCOVA. RESULTS: This study shows that the western doctors have negative attitude on Korean Traditional Medicine(M=1K8, SD=5.2). They thought Korean Traditional Medicine was not reliable because it was not scientific(79.4%). Doctor, who didn't take oriental medical education, preferred unification of health care system, but it was not statistically significant. Those who experienced oriental medical education used oriental medical treatment more frequently(F=1.17, p=0.04). The more positive attitude they have about Korean Traditional Medicine, the more frequently they refereed the patient to oriental medical doctor(t =3.57, p =0.0004). CONCLUSIONS: Western medical doctors have a negative attitude on Korean Traditional Medicine. Doctors, who did not have oriental medical education, preferred unification of health care system, but it was not statistically significant. In summary, the lack of mutual respect and understanding between doctors of the Western and Korean Traditional Medicine prevent unification of medical care system.

Study on Mean Birth Weight and Medical Care System at City Hospital

Since Dongboo City Hospital cares patients with medicaid and poor socio-economic status in large percentage, we analized all the newborns delivered at the hospital from 1984 to 1992 by their birth weights, gender, gestational age and their Medical Care System. We found our babies?mean birth weight was lower than National standard mean birth weight of 1975 and 1985 (published by KPA) and also lower than other reported studies. But the fact than mean birth weight has been increasing since 1990 is encouraging.