上海市儿童医院的特需门诊室什么意思
上海市儿童医院的特需门诊室什么意思
09-02-13 &匿名提问
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& 11/8/2011 AM 9:44:11&
来源：铁岭日报
&&&&& 前不久，银州区柴河街平安社区居民杨丽君在市中心医院铁路分院就诊时，幸运地遇到了来院坐诊的中国医科大学附属盛京医院的内科专家，当天，省专家亲自手术，困扰她多年的子宫肌瘤被成功切除了。
　　如今老百姓看疑难杂症不用再往省城大医院跑了，在家门口的医院就能享受到省城大医院专家的诊治。
　　省专家坐诊本地医院
　　对于因慢性病而三天两头去昌图县第一医院就诊的老病号、昌图镇居民李永裕来说，在那里接受省里大医院的专家诊治已经不足为奇了。因为从2008年6月昌图县第一医院与中国医科大学附属第一医院建立协作关系起，就不时地有各科专家来医院坐诊。
　　昌图县第一医院外联部主任刘跃告诉记者，没与省级大医院建立协作关系以前，由于医疗设备与技术水平有限，有些疑难杂症医院看不了，患者只能转院，后来许多患者干脆直接到省城医院就医，致使医院的门诊量逐渐减少。日起，昌图县第一医院与中国医科大学附属第一医院建立了协作关系，遇到疑难病例，不但可以通过网络平台邀请医大一院专家进行远程会诊，还能邀请专家来当地主刀，实施疑难复杂的大型手术。截至目前，共邀请中国医大一院专家来院出诊70多人次，涉及的科室从最初的心内科、神经内科扩展到骨科、妇科、儿科、眼科、耳鼻喉科、影像科、彩超室、护理部等18个科室。自去年7月起，中国医科大学附属第一医院还帮扶昌图重点建设了脑外科、泌尿外科和骨科科室，每月第一周、第三周的周一派这3个科室的专家到昌图坐诊、会诊、查房和进行手术指导。
　　市卫生局医政科科长王长军说，近两年，在卫生部开展的万名医师下基层活动中，省级大医院与我市多家医院建立了对口帮扶、支援关系。目前，我市的县级医院基本都有省医院专家来院坐诊的经历，少则每年五六次，多则20余次。
　　今年，又有20多名中国医科大学附属第一医院等省级医院的专家到我市各医院坐诊。自去年起，银州区医院、市妇婴医院等医院还与中国医科大学附属盛京医院结成了联盟医院，遇到医疗技术难题，盛京医院可随时派医疗专家来院坐诊。据统计，省大医院专家平均每年来我市各医院坐诊百余人次，受益患者1000余人。
　　花本地价看省专家
　　5月初，昌图县第一医院泌尿外科手术室内，在中国医科大学附属第一医院泌尿外科专家杨春玲亲自主刀下，王宏宇被成功摘除了右肾。原来，家住昌图县昌图镇、今年40多岁的王宏宇患上了肾积水，如果不及时手术，脏器充水挤压将会致使身体多个脏器感染。而昌图县医院做此类手术尚缺少经验，没有把握，他只能到省、市级医院完成手术。杨春玲大夫的到来为王宏宇解除了后顾之忧，他在当地直接完成了手术。王宏宇说：“听医生说，同样一个手术去省城医院做，怎么也得花2万多，而我整个手术才花了7000多元，医疗保险还能报销3000多，自己实际就花4000块钱，方便又实惠!”
　　家住银州区的李新奇，眼睛斜视伴随他度过了30多年。得知中国医科大学附属第二医院眼科专家来银州区医院坐诊、亲自主刀的消息后，他在银州区医院实施了手术。当日，与李新奇一起接受手术的还有两名斜视患者。李新奇告诉记者，多年来一直想做手术，却总是担心本地医生的技术水平，听说有省专家下来坐诊就来了。李新奇给记者算了笔账，他在铁岭本地做手术才花了1000多元，单手术费用就比沈阳大医院便宜了近一半，此外，还有车费、住院费、伙食费等，算下来能少花近3000元。目前，他的视力已经恢复正常。
　　医院实现社会效益、经济效益双丰收
　　提起省级医院专家下来坐诊，昌图县第一医院泌尿外科主任王月辉深有感触。他告诉记者，毕竟县级医院接触的病例有限，许多手术还没有把握，还有的手术技术比较原始、陈旧。“省专家下来一般都是上午坐诊，下午制作幻灯片为我们讲课。通过跟随专家坐诊、会诊、查房，我们学习到了许多边缘医学知识、规范的手术操作方法。像前列腺切除手术，我就学会了经尿道切除，切口小，术后恢复快，患者很满意。”银州区医院眼科医生郝仲利说，通过省专家手把手指导，学会了许多眼科疾病的手术方法，受益匪浅。
　　昌图县第一医院外联部主任刘跃说，省专家下来坐诊，对医院来说是社会效益与经济效益双丰收的事，不仅能提高医务人员的技术水平，也增加了医院的人气，提高了医院的知名度。
　　两种方式邀请省专家坐诊
　　在采访中记者了解到，患者可以在两种情况下享受省医疗专家坐诊：一是患者就诊的医院向省级对口支援医院、联盟医院提出邀请。这种情况下，一般是医院出现同类疾病患者较多，或者患者较为集中，而医院在医疗设备、技术方面没有十足的把握；二是患者本人或家属主动向当地就诊医院提出邀请省级大医院专家来坐诊。两种情况下，患者需要承担的费用是有差别的。市卫生局医政科科长王长军说，根据有关文件规定，省级大医院专家下来会诊时，会诊中涉及的会诊费用按照邀请医疗机构所在地的规定执行。差旅费按照实际发生额结算，不能重复收费。属医疗机构根据诊疗需要邀请的，差旅费由医疗机构承担；属患者主动要求邀请的，差旅费由患者承担。而当省级医疗专家在会诊过程中发生医疗事故，则由邀请专家的医疗机构按照《医疗事故处理条例》的规定进行处理。
作者：佚名& 责任编辑：铁岭县人民政府办公室
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青海医院对口支援工作在我省启动。从今年起，辽宁省17所三级医院将对口支援我省17所州县级医院。辽宁省三级医院为期3年的技术援助，将对提高我省州县级医院的管理能力和医疗技术起到积极的促进作用。
据了解，第一轮西部大开发以来，辽宁省对我省在经济社会领域给予很多援助。今年，国家确定并安排辽宁省对口支援我省，借力加快发展我省医疗卫生事业，推动我省医疗卫生事业更快更好发展。此次辽宁省17所三级医院与我省17所对口支援州县级医院签订为期3年的协议。辽宁省17所三级医院作为支援医院，将通过示范手术、专家坐诊、进修培训、专题讲座等多种形式的指导，对我省17所对口支援州县级医院在医院管理、学科建设、人才培养、信息化沟通等方面给予支持。(作者：王紫 高列)
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：&&&&权力声明：若本站收录的文献无意侵犯了您的著作版权，请点击。摘要:（摘要内容经过系统自动伪原创处理以避免复制，下载原文正常，内容请直接查看目录。）研讨配景西医药作为中华平易近族的珍宝，包含着丰硕的哲学思惟和人文精力，是我国文明软实力的主要表现。历久以来，西医药和中医药相互弥补、调和成长，配合担当着保护和促进国民安康的义务，这是我国医药卫闹事业的主要特点和明显优势。西医药临床疗效确实、预防保健感化奇特、医治方法灵巧、费用比拟昂贵，特殊是跟着安康不雅念变更和医学形式改变，西医药愈来愈显示出奇特优势。县级西医院是我国医疗办事机构的主要构成部门，是三级医疗卫生办事收集的龙头。应当施展龙头的感化，进步下层的西医药办事才能从而知足城乡居平易近的请求。西医药的基本在乡村，宽大农人须要西医药，县级西医院是乡村西医药医疗、预防、保健中间，承当乡村西医药预防保健，根本医疗等义务。县级西医院作为乡村西医药办事收集的骨干力气，关系着乡村传统医药的兴衰成败，对全部西医药事业无足轻重，影响深远。然则县级西医院今朝存在着当局财务支撑缺乏、治理构造不敷健全、人才网job。vhao。net梯队不公道的成绩、西医医疗办事效力低劣等成绩。个中西医医疗办事效力低下是今朝县级西医院面对的最严重的成绩，今朝关于病院医疗效力的研讨重要集中在：某种身分对医疗办事效力的影响、医疗机构医疗办事效力评价、病院效力的影响身分研讨等方面，然则研讨西医院医疗办事效力，特别是对县级西医院西医医疗办事效力的研讨比拟少，并且病院效力的影响身分重要集中在外部身分基于以上的剖析本研讨提出四个研讨成绩，详细为：(1)县级西医院西医医疗办事的近况若何？(2)县级西医院西医医疗办事的效力如何？(3)影响西医院西医医疗办事效力的身分是甚么？(4)若何进步西医院的西医医疗办事效力？研讨目标本研讨的整体研讨目的是经由过程剖析山东省县级西医院西医医疗办事近况，剖析西医医疗办事效力，依照治理情况实际构建本研讨的影响身分评价目标系统，定量剖析影响西医医疗办事效力的身分，提出进步西医医疗办事效力的政策建议。详细的研讨目的：1。详细剖析山东省西医院西医医疗办事近况。经由过程描写性剖析发明山东省西医医疗办事现存的成绩。2。针对现存的成绩，采取数据包络剖析办法(DEA)剖析山东省县级西医院西医医疗办事效力状态，重点包含各综合技巧效力(Techinical Efficiency)、纯技巧效力(Pure Techinical Efficiency)和范围效力(Scale Efficiency)停止剖析。综合效力应用不变范围待遇(CRS)模子，应用可变范围待遇(VRS)模子详细剖析纯技巧效力和范围效力，而且对对非有用县级西医院病院在投入、产出方面存在的重要成绩停止定量剖析。3。依据上述研讨，针对山东省西医医疗办事效力的影响身分，应用文献研读、专家征询和条理剖析办法(AHP)肯定影响身分的评价目标系统。4。基于上述影响身分目标系统，应用Tobit回归办法对影响病院效力的身分停止回归剖析，找出明显影响病院效力的目标，并剖析各目标与效力高下的相干关系并对影响病院效力的身分停止体系的实际剖析。研讨办法本研讨为横断面研讨，样本病院为山东省101所县级公立西医院(以下称县级西医院)。研讨材料起源于2010年山东省卫生厅西医药治理局展开的全省西医根本近况普查任务。1、数据包络剖析办法(DEA)关于DEA模子的拔取，运用不变范围待遇(CRS)模子和可变范围待遇(VRS)模子，CRS和VRS模子不须要起首设定病院的临盆函数和有效率项的散布假定，而是应用数据包络剖析的办法构建出最好理论面，将决议计划单位同最好的决议计划单位比拟较，盘算出每一个单位的效力值。CRS模子测定的是病院的技巧效力(Techinical Efficiency)也叫综合效力，即在给定的投入的情形下病院获得最年夜产出的才能，然则CRS模子没法解释有效率的缘由是因为技巧有效率照样范围有效率，是以须要应用VRS模子将技巧效力进一步的剖析为纯技巧效力(Pure Techinical Efficiency)与范围效力(Scale Efficiency)。本文彩用的以产出为导向的DEA模子即在投入必定的情形下，懂得产出的效力情形。变量的拔取异常症结，可以或许影响模子的质量。所以我们应用了Pastor等人基于周密的数学论证和推导提出的DEA研讨中较为有用的挑选变量办法，也称为Pastor办法。2、影响身分目标系统构建办法文献剖析后初步肯定了影响身分目标系统，经由过程两轮德尔菲法肯定了影响身分目标系统，而且应用条理剖析法(AHP)来肯定影响身分目标系统的目标权重。3、材料剖析的办法应用描写性统计剖析对西医院西医医疗办事近况停止剖析，找到近况中存在的成绩，对投入产出目标停止描写和比拟，而且对影响身分各个目标的根本特点停止描写。应用Tobit回归对影响身分目标系统停止定量剖析。本论文剖析进程重要分为三部门，第一部门对县级西医院的西医医疗办事近况停止描写性剖析；第二部门应用数据包络剖析办法从投入产出方面来盘算县级西医院西医医疗办事效力及有效率病院的投影剖析；第三部门应用Tobit回归对影响办事效力的身分停止剖析。研讨成果1、样本病院西医医疗办事展开情形从近况剖析可以看出山东省根本树立了西医药办事收集，山东省共有公立西医病院(中中医联合病院)123所，个中，省级2所，市级17所，县级西医院101所。全省初步树立了以县(市、区)级西医病院为龙头，乡镇卫生院、社区卫生办事中间西医科为骨干，村卫生室、社区卫生办事站为依托的下层三级西医药办事收集，在疾病防治中施展了奇特的感化。据统计，县(市、区)级西医病院总诊疗人次数为1019万人次，占全省公立西医病院总数的65。88%。西医方面卫生人力所占比例不高：山东省公立西医院人才网job。vhao。net部队初具范围，全省县级西医院中编制人员总数为20746人，个中卫生技巧人员21775人；执业医师为8492人，西医种别执业医师为3079人，占执业医师的比例为36。23%；执业助理医师为782人，个中西医种别执业医师为180人，所占比例为28。26%；注册护士为7372人，期中具有西医办事才能的护士为所占的比重为66。64%。西医方面的卫生装备举措措施所占比重较小：山东省县级西医院医疗装备总值为千元，个中西医特点诊疗装备总值为418661千元，占到医疗装备总值的0。61%。山东省县级西医院上报医用装备中，总量居前三位的是人工肾透析装配、危宿疾人监护体系、医学影象存档传输体系，数目分离为561套、464套、398套。西医药办事所占比重偏低：全省县级西医病院承当了全省病院13。26%的门诊办事量和11。80%的住院办事量；中药饮片处方数和中成药处方数分离占总处方数的53。66%；山东省县级西医院总诊疗人次数为人次，个中门诊人次数为9282207人次，西医专家门诊人次为1695189人次，占门诊人次的18。26%。山东省各县级西医院可以或许应用的西医疗法种数均匀为14种，可以或许应用按摩疗法的县级西医院数目最多，占一切县级西医院的99。01%，其次为拔罐疗法，占98。02%。西医种别经费所占卫生经费比例偏低：山东省县级西医院财务补贴支出为204314千元，占县级西医院总支出的5。80%，西医医治支出为305052千元，占医疗支出的18。31%。中药支出占药品支出的19。03%，中药费收入占药品收入的16。74%，而在中药费收入中，中成药费的收入占了44。87%，院内制剂仅占5。68%。2、西医医疗办事效力剖析本研讨应用数据包络剖析办法中的CRS模子和VRS模子，拔取与西医医疗效力相干投入和产出目标剖析山东省101家县级西医院西医医疗办事效力，研讨成果注解：(1)山东省县级西医院西医医疗办事效力整体剖析：从整体上看综合效力有用的县级西医院为51所，综合效力均匀值为50。50%。纯技巧效力有用的县级病院为55所，纯技巧效力有用比例为54。46%。范围效力均匀值为96。40%，范围效力有用的病院为52所，范围效力有用比例为46。53%。范围待遇不变的为47所，范围待遇递加的病院为33所，范围待遇递增为21所。按效力得分分组，高分组为0。9分以上，中效力组为0。6一0。9，低效力组为0。6以下。各效力分值均为高分组中数目最多，技巧效力中高分组为53家，均值为0。998，纯技巧效力中，高分组为55家，均值为1。000，范围效力中高分组有74家，均值为0。989。而技巧效力有用和纯技巧效力有用的病院都很少，分离为4家和6家。(2)按范围分组剖析：按范围分组可以看出综合效力有用比例和纯技巧效力有用比例最高的均为年夜范围，比例分离为88。80%和90。40%。而综合效力有用比例和纯技巧效力有用比例最低的均为中范围组，比例分离为43。50%和44。40%。范围效力状况中，范围递加所占比重最多的组别为中范围组，比例为88。30%，而范围递加所占比重起码的组则是中小范围，比例为31。81%。并且看出县级西医院的综合效力和纯技巧效力跟着范围的扩展出现出先升然后再下降然后再年夜幅度上升的趋向。县级病院的中范围组的综合效力和纯技巧效力最低，均匀值分离为0。480和0。520，而年夜范围组的综合效力和纯技巧效力都为最高，分离为0。888和0。901。而范围效力则表示比拟陡峭，范围效力最高的也为年夜范围组，均匀分为0。983，最低也为中范围组，均匀分为0。883。范围收益不变的情形中，中小范围和中年夜范围的范围收益不变的比例较年夜，分离占到了45。50%和60%。而整体情形中50。50%的病院处在范围收益不变的情形。范围收益递增的情形下看，中年夜范围和年夜范围都为0所病院，所占比例也都为0。00%，而小范围和中范围中范围收益的比例较高，分离为27。30%和27。80%。而整体情形看唯一12。87%的病院为范围递增状态。从范围递加的情形看，中小范围和中范围的所占的比例最高，分离以为45。50%和38。90%。从整体上看36。63%的病院处于范围递加状况。(3)依照市域剖析：综合效力，纯技巧效力和范围效力最高的城市为威海市，都为有用决议计划单元。而技巧效力，纯技巧效力最低的为枣庄市，分离为0。420、0。480，范围效力最低为滨州市仅为0。781。(4)按地区剖析：从表中可以看出东部的县级西医院为31所，中部为20所，而西部为50所，占总样本的49。50%，东部的县级西医院为31所。西部西医院的技巧效力最低为0。583，中部的纯技巧效力最高位0。769，东部的范围效力最高位0。941。从范围待遇来看，中部地域的仅为递加和不变，没有病院范围须要递增，而东部为递加8所，递增3所，不变成9所。(5)非DEA有用决议计划单位的投入产出投影剖析：非整体有用决议计划单位在一切投入目标均有分歧水平的多余与糟蹋。西医执业助理医师这个目标现实均匀值为1。782人，然则目的值仅1。022人，多余的比例为42。70%。西医特点诊疗装备总值现实均匀值为414。52万元而目的值仅为78。2万元，多余比例到达80。90%。一切的产出目标均未到达目的值，个中可以或许应用的西医疗法种数这个目标间隔目的值还有28。966，差距比例为68。04%。3、西医医疗办事效力影响身分剖析用Tobit回归剖析办法对101家县级西医院的西医医疗办事效力的影响身分停止剖析，分离从病院内部身分和病院的外部竞争身分两个方面停止剖析：(1)内部微观身分剖析：影响病院效力的重要的内部微观身分重要是行政区域地盘面积(平方千米)p值为0。013，在0。05的程度上成心义，影响系数为正向0。615和政策搀扶力度这两个目标。在对三个效力的影响中，西医院的搀扶力度这个目标和病院取得财务补贴数占区域内病院财务补贴比例这连两个目标的影响系数均为正值，是以解释西医院的搀扶力度和病院取得的财务补贴和西医院的西医医疗办事效力之间的正相干，且西医院的搀扶力度和病院取得财务补贴数占区域内病院财务补贴比例两个目标在三个模子中均经由过程了明显性磨练。这解释，政策的搀扶力度可以或许增进西医院的的西医医疗办事效力(2)内部微不雅身分：影响病院的内部的微不雅身分也就是竞争身分中我们可以看出病院卫生技巧人员占区域内卫生技巧人员数比例这个身分对三个效力值均有影响，并且均有统计学意义，而且回归系数为负值，这解释，卫生技巧人员所占的区域内卫生技巧人员比例越多，效力越低，人员越多，病院的压力越年夜，越轻易展开更能盈利的中医诊疗方法。(3)病院外部竞争身分剖析：可以看出，多半的目标对效力的影响不明显，唯一中药支出占药品支出的比例、中药费的收入占药品收入的比例对综合效力和纯技巧效力有影响，而一切的目标对范围效力的影响均不明显，这解释，药品支出和药品的收入影响西医医疗办事效力。结论与政策建议本研讨从县级西医院的外部身分剖析，发明县级西医院西医医疗办事存在许多的成绩，起首，西医院固然办事才能慢慢晋升，然则欧化的比拟严重。今朝的的县级西医院西医医疗办事效力整体不高，而且县级西医院中范围经济与范围不经济的情形并存，同时还发明，病院中的西医方面的卫生技巧人员和护理人员供给西医药办事的积极性不高，在病院外部的竞争身分中，发明中药药品支出占药品支出的比例和中药费收入占药费收入的比例这两个目标对效力的影响有统计学意义。从内部身分剖析可以看出，微观的内部情况身分中，经济成长状态好的地域的县级西医院西医医疗办事效力越低，对西医药的搀扶力度也能有用的进步县级西医院的办事效力，在微不雅的内部情况身分中可以看出卫生技巧人员所占区域内卫生技巧人员比例这个目标成心义，且影响为负向。依据本研讨的结论提出以下的政策建议：病院外部身分办法：起首县级西医院应当做到以西医为重，尽力进步西医在严重疾病中的介入性，进步西医院的办事质量和临床疗效，扩展目标规模；其次县级西医院应当增强县级西医院的西医医疗办事程度；再次进步西医方面的卫生技巧人员和护理人员的供给西医办事的积极性。病院的内部身分办法：起首国度的应当扩展对西医院的搀扶力度，公立西医院长短营利性的医疗机构，是当局实施必定福利政策的公益事业的一部门，当局投入缺乏晦气于公立西医院公益性的表现，也很难增进西医医疗办事的展开；其次国度应当从政策上搀扶，除财务投入外，更多的应当是政策上的搀扶。Abstract:On the background of Western medicine as the Chinese national treasure, contains rich philosophy and humanistic spirit, is the main manifestation of the civilization of our country's soft power. Long-term since, western medicine and traditional Chinese medicine to make up for each other, coordinate development, with play to protect and promote national health obligations, which is China's medical and health services the main characteristics and obvious advantages. Western medicine clinical curative effect really, prevention effect of health care of strange and cure dexterity, cost relatively expensive, special is followed in Ankang indecent concept change and medical form change, west medicine is increasingly showing more and more unique advantages. West County Hospital is the main part of China's medical offices, three medical and health service network of the leading. Should play the leading role, the progress of Western medicine which can lower work content of urban and rural residents' request. Western medicine basic in the country, and the broad farmer need to western medicine, West County Hospital is a rural western medicine of medical treatment, prevention, care, bear country western medicine prevention and health care, basic medical and other obligations. West County Hospital as the rural western medicine service backbone collection of rural strength, the relationship between the traditional medicine of the success or failure of all the western medicine of little importance and far-reaching influence. But now the western medicine hospital there is a lack of financial support of the authorities, governance structure, imperfect talent network job. Vhao. Net echelon unfair performance, efficiency and poor performance of Western medicine. Work of Chinese and Western medicine medical inefficiency is the current County West hospital is facing the most serious results. Today about the hospital medical effectiveness research important focus on: some factors on medical services effect influence, medical institutions medical service effectiveness evaluation, influence the validity of the hospital components research, however research west hospital medical work force, especially of county-level hospitals of Western medicine medical service effectiveness study comparing less, and hospital effect factors important concentration in external factors based on analysis of the above, this study proposed four research achievements, in detail: (1) County Hospital of the west western medical service present situation how? (2) how to effect western medical services of the West County hospital? (3) the impact of Western medicine efficiency in western hospital is what? (4) how to improve the West hospital medicine medical service? The purpose of the study in this study, the overall purpose of the study is through the analysis of the process of Shandong Province County Hospital of the west western medical work status, analysis of Western medical efficiency, according to the situation of governance to actually build the study influencing factor appraisal target system, quantitative analysis of factors affecting the Western medical do effect, put forward progress western medical service effectiveness of policy recommendations. The detailed research objective: 1. A detailed analysis of Shandong Province, western medicine hospital medical service status. Through the descriptive analysis method in Shandong Province Western medical service problems. 2. In view of the existing problem, take data envelopment analysis (DEA) analysis of Shandong Province County Hospital of the west western medical service validity status, including the comprehensive skill effect (Techinical efficiency pure skill effect (pure Techinical efficiency) and effectiveness (scale efficiency analysis. Comprehensive effect and the application of the same treatment range (CRS) model, using a variable range of treatment (VRS) model a detailed analysis of pure technical efficiency and scale efficiency and the non useful County Hospital of the West Hospital exists in the aspects of input and output of important achievements of quantitative analysis. 3. Based on the above research, in view of the influence of Shandong Province Western medical service effectiveness of identity, literature study, expert consultation and application level analysis method (AHP) is bound to affect the evaluation target system of identity. 4. Based on the influence factors of the target system, and applies the Tobit regression method on the effect of influencing hospital identity stop regression analysis, to identify significantly affect the hospital binding targets, and analyze the goal and effect to compete with the coherence and the effect of hospital effect of identity system of the actual analysis. Methods this study was a cross-sectional study, samples of hospital in Shandong Province as the 101 County-level Public Hospital West (hereinafter referred to as the western medicine hospital). The basic situation of Western medicine research material survey mission originated in 2010 in Shandong Province health department administration of Western medicine. 1, data envelopment analysis (DEA) DEA model on the choice, use of invariant treatment range (CRS) model and variable range treatment (VRS) model, CRS and VRS model does not need the chapeau set hospital birth function and the effective rate of spread is assumed, but the application of data envelopment analysis method of constructing a theory of best, decision unit with the best resolution plan comparison is, the calculation of the effectiveness of a per unit value. Determination of CRS model is hospital skill effect (Techinical efficiency) of the called the comprehensive effect, that is, in the given input hospital acquired most of the eve of the output to, however CRS model can't explain why efficiency is because of the technique efficiency still scope efficiency, is to need to use VRS model will skill effect further analysis for efficiency of pure Techinical efficiency and scope of validity (scale efficiency pure technical is. The color used to output oriented DEA model is in certain circumstances, the effectiveness of case understand output. Select the crux of abnormal variables, may affect the quality of the mold. So we use the Pastor variable selection method is more useful, DEA research thorough mathematical proof and proposes the measures based on, also known as Pastor. 2, the impact of the identity of the target system construction method literature analysis initially affirmed influencing factor target system, through two rounds of Delphi affirmed the influence factors of the target system, and application of coherent analysis hierarchy process (AHP) to determine the weight of influence factors of the target system. 3, analyze ways to use the description statistical analysis of Hospital of the west western medical service present situation analysis, find the status quo of achievement, of input output target stopped writing and compared, and the fundamental characteristics of influencing factor of each target stopped writing. Application of Tobit regression to the target system to carry on the quantitative analysis of influencing factor. The analysis process of important points to three parts, the first Department of the County West Hospital of Western medical service status stop
the second part using data envelopment analysis method from the aspects of input and output to computer County Hospital of the west western medical efficiency and a projection of hospital third sector using Tobit regression to affect the service effect of factor analysis. Research results 1, the sample hospital of traditional Chinese and Western medicine medical service expansion situation from the analysis of the status quo can be seen in Shandong Province basic set western medicine service network, Shandong Province a total of public western medicine with hospital and Chinese medicine hospital 123, medium, at the provincial level 2, level 17, at the county level hospital of West 101. The province initially set to the county (city, district) level West doctor-patient hospital as a leader, township hospitals, community health service middle western medicine as the backbone, village clinics, community health service stations for relying on the lower Tertiary western medicine service network, in the prevention and treatment of diseases of the cast strange feeling. According to statistics, the county (city, district) level of Western medicine hospital clinic visits for 10 million 190 thousand people, accounting for 65 of the province's public medical hospital. 88%. Western medicine health manpower proportion is not high: Shandong Province Public Hospital West talent network job. Vhao. Net forces took shape, the province county West in the hospital preparation the total number of staff to 2 mediu practicing physicians for the 8492 people, western medicine for different types of medical practitioners to 3079 people, accounted for the proportion of physicians practicing for 36. 23%; assistant practicing doctors for 782 people, a kind of traditional Chinese medicine and Western medicine practitioners 180 people, accounting for 28. 26%; registered nurses of 7372 people, has the ability of Western medicine nurses accounted for 66. 64%. Western medical equipment facilities accounted for a smaller proportion of: Shandong Province County West hospital medical equipment gross for
thousand yuan, the medium characteristics of Western medicine diagnosis and treatment equipment with a total value for 418661 thousand yuan, accounted for medical equipment with a total value of 0. 61%. Shandong Province County West hospital reported medical equipment in, the total population of the artificial kidney dialysis assembly, Suji risk monitoring system, medical image archiving and communication system, the number of separation for 561 sets, 464 sets, 398 sets. West Pharmaceutical Services: low proportion of the province's county hospital took the western medicine hospital 13. 26% and 11 outpatient service. 80% of the hospi separation of Chinese herbal medicine and traditional Chinese medicine prescription prescription number accounted for 53 of the total number of prescription. 66%; Shandong Province County West hospital clinic visits to
passengers, the visits to 9282207 passengers, western medicine specialist clinic attendance of 1695189 people, accounting for 18 of the number of outpatients. 26%. Western Hospital of Shandong Province county level can perhaps application western medicine species even for 14 species, number of West Hospital at or above the county level may use massage therapy is the largest, accounting for 99 of the all County West hospital. 01%, followed by cupping therapy, accounting for 98. 02%. Western medicine category funding for health expenditure proportion is low: Shandong Province county hospitals in western financial subsidy spending for 204314 thousand yuan, county hospital of the West Branch of 5%. 80%, western medicine treatment expenditure was 305 million 52 thousand yuan, accounting for 18 of medical expenses. 31%. Chinese medicine expenditure accounted for 19 of drug expenditure. 03%, Chinese medicine fee income accounted for 16 of the income of drug. 74%, while in the traditional Chinese medicine fee income, in medicine income accounted for 44. 87%, hospital preparations accounted for only 5. 68%. 2, Western medical service efficiency analysis in this study, using data envelopment analysis approach in the CRS model and VRS model, select and Western medical effect of coherent input and output target analysis in Shandong Province 101 county-level hospital of the west western medical efficiency, research notes: (1) Shandong Province County Hospital of the west western medical service overall effectiveness analysis: look from the whole of comprehensive effect of useful County West Hospital for 51, the comprehensive effect and uniform 50. 50%. Pure skills useful for the effectiveness of hospital 55, pure effectiveness ratio of 54 useful skills. 46%. The scope of validity of the uniform value is 96. 40%, the scope of validity of useful hospital is 52, the scope of validity of useful ratio of 46. 53%. The scope of the same treatment to 47, increasing the range of treatment hospital for 33 to 21, increasing range of treatment. According to the effect of high score group, group 0. More than 9 points, in effect group was 0. 6 a 0. 9, the low effect group was 0. The following 6. The effect of the score was high in the largest number of packet, high packet 53 skills in effect, the average is 0. 998, pure skills effect, high score is 55, the average is 1. 000, the scope of validity in the high score of 74, the average is 0. 989. The effect and effectiveness of pure skills useful skills useful in hospital are rarely separated into 4 and 6. (2) according to the scope of analysis: according to the range of packet packet can be seen in the comprehensive effect and useful proportion and pure skills are the highest proportion of useful effect of large-scale separation was 88, the proportion of. 80% and 90. 40%. The comprehensive effect of useful proportion and pure skills effect was in the range of the minimum useful proportion is separated into 43 group. 50% and 44. 40%. The scope of validity of status, scope of increasing the proportion of groups in most of the group, the proportion is 88. 30%, while increasing the proportion of the minimum range is the range of small groups, the proportion is 31. 81%. And see the comprehensive effect of the western medicine hospital and follow the extension of pure skill effect showed first increased and then decreased again and then greatly rising trend. In the range of comprehensive effect of group of county-level hospitals and the lowest average effectiveness of pure skills, separated into 0. 480 and 0. 520, the comprehensive effect of large-scale group and pure skill effect is the highest, separated into 0. 888 and 0. 901. The scope of validity of said relatively steep, the scope of validity of the highest for the large-scale group, divided into 0. 983, the minimum is in the range of groups, divided into 0. 883. The range of constant returns in the case of small and medium range and range, constant income range of middle-aged night a larger proportion, separation accounted for 45. 50% and 60%. While the overall situation in 50. The 50% hospital in the range of constant returns to the situation. The range of increasing returns under the circumstances, the middle night range and large-scale hospital was 0, the proportion is 0. 00%, a small high range and range in the scope of income ratio, separated into 27. 30% and 27. 80%. While the overall situation to see only 12. 87% of the hospital for increasing range. From the scope of the increasing situation, the proportion of small and medium range and in the range of the highest separation thought 45. 50% and 38. 90%. 36 on the whole. The 63% hospital in the range of increasing status. (3) according to the analysis of city comprehensive efficiency, pure technique efficiency and scale efficiency is the highest city in Weihai City, are useful for decision unit. While the skill effect, pure skills effect is the lowest in Zaozhuang City, separated into 0. 420, 0. 480, the scope of validity of the minimum for the city of Binzhou is only 0. 781. (4) by Region Analysis: as can be seen from the table at the county level hospital is the 31 west east, middle and West 20, 50, 49 of total sample. 50%, the west is the 31 Eastern hospital. In the west of the hospital for a minimum of 0 playing skills. 583, the effect of the high pure skills of middle 0. 769, the scope of validity of the eastern most high 0. 941. Treatment range from the point of view, the central region of only incremental and constant, no hospital needs increasing, while the eastern 8 incrementation, increasing 3 and does not become a 9. (5) the analysis of input-output projection DEA useful decision unit: non useful decision units in the overall excess and spoil everything into the target have different level. Western medicine physician assistants this goal average is 1 reality. 782 people, but the objective value is only 1. 022, the excess ratio of 42. 70%. The reality of Western medicine characteristics of medical equipment gross average is 414. 520 thousand yuan and the objective value is only 78. 20 thousand yuan, the excess rate reaches 80. 90%. There are 28 all target output did not reach the goal value, one can perhaps application of Western medicine therapy species the target interval objective value. 966, the gap ratio of 68. 04%. 3, Western medical work effect influencing factor analysis using Tobit regression analysis on 101 county-level hospital of the west of the Western medical service to the influencing factor of the effectiveness of the analysis, separated from the two aspects of the hospital internal identity and the hospital's external competitive factors analysis: (1) internal micro element analysis: effect of influencing hospital important internal microcosmic factors important is the administrative areas of the site area (square kilometer) P = 0. In 013, 0. 05 degree of sense and influence coefficient is positive 0. The two goals and 615 policy support. In the influence of three effect, hospital of the West helped efforts to this goal and the hospital made financial subsidies accounted for regional hospital financial subsidy proportion that even two goals of the influence coefficient is positive, is to explain the hospital of the west arm between strength and hospital financial subsidies and West Hospital of Western medical work efficiency is coherent and hospital of the West helped efforts and hospital made financial subsidies accounted for within the region hospital financial subsidy proportion of two goals in three model through the explicit hone. This explanation and policy helped efforts can perhaps improve hospital, west of the Western medical work efficiency (2) internal micro indecent identity: influence of the hospital internal micro indecent identity also is the competition factors we can see hospital health technical personnel account for regional skills of health personnel number ratio of the identity of three effect value were affected, and there were significant, and the regression coefficient is negative, explain this, health technical personnel account for regional health technical personnel more, efficiency is low, more staff and hospital of the pressure is greater, more easily spread more profitable method of TCM diagnosis and treatment. (3) hospital external competition status analysis: as you can see, the impact on the efficacy of most of the target is not obvious, the only Chinese spending accounted for the proportion of drug expenditure, medicine fee income accounted for drug income proportion of comprehensive effect and pure skill effect influence, and all goal of scale efficiency effects were not obvious, explain this, the drug expenditure and drug revenue impact of Western medical work efficiency. Conclusions and policy suggestions in this study from the West County Hospital by external factors analysis, invention of county-level hospitals of Western medicine medical service existed many scores, first and foremost, West hospital course work can be slowly promoted, however the Europeanization of unmatched serious. Currently the county hospital of the west western medical service overall efficiency is not high, and the economies and diseconomies of scope of the county-level hospitals of West coexist, it was also found, western medicine hospital health technicians and nurses supply western medicine work enthusiasm is not high, in outside the hospital competition factors invention drug spending as a share of drug expenditure and the proportion of the traditional Chinese medicine fee income accounted for effect of drug income proportion of the two target of validity was statistically significant. From the internal factor analysis can be seen, micro internal factors, regional economic growth state of county-level hospitals of West Western medical work efficiency is low, on the effect of Western medicine to assist the efforts also can be useful progress County West of the hospital service, in micro internal situation factors can see health technical staff accounted for the proportion of health technical personnel in the region this goal mean meaning and influence is negative. Put forward the following policy suggestions according to the conclusion of this study: hospital external factors way: chapeau County West hospital should do with western medicine for heavy, try to progress of traditional Chinese and Western medicine in severe disease interventional, progress West hospital service quality and clinical curative effect,
the County West hospital should strengthen county-level hospitals of Western medicine m again progress supply western medicine Western medicine health personnel skills and nursing staff's work enthusiasm. The hospital's internal identity way: chapeau country shall be extended to the hospital of the west arm strength, public West hospital length of for-profit medical institutions, is certain welfare policy of the public welfare sector authorities implement, the authorities put the lack of bad luck in the West welfare of public hospitals, is hard to enhance the
secondly nations should from the policy helped, in addition to the financial investment, more should is supported by the policy.目录:CONTENTS6-8中文摘要8-16Abstract16-25第一章 前言26-35&&&&1.1 研究背景26-29&&&&1.2 研究现状与研究问题29-31&&&&1.3 研究意义与研究目标31-32&&&&1.4 本论文的结构框架32-35第二章 文献综述35-53&&&&2.1 中医医疗服务效率相关概念界定35-36&&&&2.2 医疗服务效率相关的理论研究36-42&&&&2.3 医疗服务效率评价方法42-45&&&&2.4 数据包络分析法45-52&&&&本章小结52-53第三章 理论模型与研究方法53-70&&&&3.2 本论文的分析框架53&&&&3.3 资料来源53-54&&&&3.4 研究方法54-68&&&&3.5 资料分析的方法68-70第四章 调查地区县级中医院的基本情况70-81&&&&4.1 样本地区基本情况70&&&&4.2 人员情况70-72&&&&4.3 基础设施情况72-76&&&&4.4 收入和支出情况76-78&&&&4.5 医疗服务情况78-80&&&&本章小结80-81第五章 基于DEA的中医院中医医疗服务效率研究81-96&&&&5.1 效率分析结果81-91&&&&5.2 非DEA有效县级中医院的投入产出的投影分析91-95&&&&本章小结95-96第六章 县级中医院中医医疗服务效率影响因素实证分析96-110&&&&6.1 影响因素指标体系96-103&&&&6.2 县级中医院中医医疗服务效率影响因素Tobit回归103-109&&&&本章小结109-110第七章 讨论及建议110-117&&&&7.1 研究方法的科学性与适用性110-113&&&&7.2 主要研究结论113-115&&&&7.3 政策建议115-117研究创新与不足117-118附录：本研究所用的调查问卷118-147参考文献147-152致谢152-153攻读博士学位期间发表的学术论文153-154附表154分享到：相关文献|