Suchergebnisse

Intro -- Dedication -- Preface -- Contents -- Part I: Pandect -- Chapter 1: Background -- 1.1 Research Background -- 1.2 Survey Program -- 1.2.1 Research Objective -- 1.2.2 Research Design -- 1.2.3 Research Content -- 1.2.4 Research Scope -- 1.2.5 Organizational Structure -- 1.2.5.1 Research Group Members -- 1.2.5.2 Research Hospital Contact Officers -- 1.2.6 Technological Roadmap (Fig.1.3) -- 1.2.7 Conducting the Investigation -- 1.2.7.1 The First Stage (February 2013 to April 2013): Preparation and Preliminary Design -- 1.2.7.2 The Second Stage (April 2013 to May 2013): Pre-investigation -- 1.2.7.3 The Third Stage (June 2013 to July 2013): Survey -- 1.3 Investigation Results -- References -- Chapter 2: Review of Chinese Public Hospital Reform -- 2.1 Overview of Chinese Public Hospital Reform -- 2.2 Practical Measures -- 2.2.1 Separation of Government Functions from Those of Institutions -- 2.2.2 Separation of Management from Operations -- 2.2.3 Separation of Prescriptions from Dispensing of Drugs -- 2.2.4 Separation of the For-profit and Nonprofit Nature of Hospitals -- 2.3 Evaluation -- 2.3.1 Progress -- 2.3.2 Problems -- References -- Chapter 3: Basic Information Survey for Large Public Hospital Reform -- 3.1 Basic Information on Medical Staff -- 3.1.1 General Information -- 3.1.1.1 Gender -- 3.1.1.2 Age -- 3.1.1.3 Position -- 3.1.1.4 Title -- 3.1.1.5 Education Level -- 3.1.1.6 Department -- 3.1.2 Economic Situation -- 3.1.2.1 Monthly Income -- 3.1.2.2 Expected Monthly Income -- 3.1.2.3 Monthly Household Expenditure Per Capita -- 3.2 Basic Information on Patients -- 3.2.1 General Information -- 3.2.1.1 Gender -- 3.2.1.2 Age -- 3.2.1.3 Marriage -- 3.2.1.4 Occupation -- 3.2.1.5 Education Level -- 3.2.2 Economic Situation -- 3.2.2.1 Monthly Income -- 3.2.2.2 Yearly Medical Expenditures -- 3.3 Summary -- 3.3.1 Basic Information of Medical Staff.

BACKGROUND: This study aims to establish a multi-agent system model to provide accurate suggestions for the policy proposal of controlling the unreasonable growth of medical expenses charged by public hospitals in China. METHODS: A multi-agent system model was employed in this study. Agents of this model were divided into patients, doctors, medical institutions, the government, and medical insurance agencies. The model was composed of two subsystems: the disease and medical-seeking subsystem, and the medical expenses subsystem. Policy intervention experiments were conducted on patients' medical-seeking preferences, doctors' public welfare behaviors, and the government's financial investment. RESULTS: At present, medical expenses in China are unreasonable and keep increasing, and the proportion of medicine and physical examination expenses to total medical expenses for public hospitals is unreasonable. Intervention experiments suggested that expanding the promotion and application of the community first-visit system could rationalize patients' medical-seeking preferences, increasing doctors' incomes and reducing workload could significantly restrict doctors' over-prescription behaviors. Also, improving the government's financial investment could guide public hospitals to strengthen their commitment to public welfare responsibilities. These interventions could decrease the unreasonable growth of medical expenses of public hospitals. The combined intervention effects on suppliers, demanders, and the government were better than the effect of these agents independently. CONCLUSIONS: The main reasons for the unreasonable increase in patient medical expenses at public hospitals could be attributed to patients' unreasonable medical-seeking preferences, doctors' weak public welfare incentives, and the government's inadequate financial investment. Policy-makers should consider proposals to restrict and guide the behaviors of suppliers, demanders, and the government, simultaneously. The government should consider the ...

Haiping Chen, Meina Li,* Zhixin Dai,* Qiangyu Deng, Lulu Zhang Department of Military Health Management, College of Health Service, Second Military Medical University, Shanghai, People's Republic of China *These authors contributed equally to this work Objective: Dual practice is defined as a physician's performance of medical activities in different health care institutions (two or more) simultaneously. This study aimed to examine the perception and acceptance of medical staff and outpatients of dual practice and explore the possible factors affecting people's perception.Methods: A cross-sectional study was conducted in 13 public hospitals in Shanghai. Participants included medical staff and outpatients. We distributed 1,000 questionnaires to each participant group, and the response rates were 66.7% and 69.4%, respectively. Statistical differences in variables were tested, and multinomial logistic regression methods were employed for statistical analysis.Results: The study included two parts: medical staff survey and outpatient survey. The results of medical staff survey showed that 63.0% of the respondents supported dual practice. Medical staff who belonged to the surgical department or held positive belief of dual practice were more willing to participate in dual practice. Moreover, the publicity activities of dual practice and hospitals' human resource management system were important factors affecting the willingness of the medical staff. The results of outpatient survey showed that 44.5% of respondents believed that dual practice could reduce difficulty in consulting a doctor. Regarding the perceived benefits of dual practice, the proportion of outpatients who believed that dual practice could meet the demand for health convenience, minor illness, and chronic disease were 45.4%, 42.4%, and 53.7%, respectively. Additionally, demographic characteristics significantly influenced the perception of outpatients.Conclusion: This study confirmed that both medical staff and outpatients generally held positive attitudes toward dual practice. Medical staff who belonged to the surgical department or held positive belief of dual practice were more willing to participate in dual practice. Moreover, the existence of publicity activities and more flexible management system of hospitals' human resource would promote physicians' willingness to participate in dual practice. In addition, perception of outpatients of dual practice was affected by demographic characteristics. Keywords: dual practice, perception of medical staff, outpatients' perception, influential factors, labor supply