State-owned Hospitals Research Articles

When 18-year-old factory worker Dou Huhai came down with a cold, after a 15-hour shift at a zipper factory on the outskirts of Beijing, he had neither the money nor the time to see a doctor so he just took some medicine. The following day, still drowsy from the medication, he caught his left hand in his punching machine. The machine that snagged Dou's hand crushed two of his fingers. He was taken to the county-town hospital, and then transferred to the Armed Police Hospital, where a doctor told him that it was going to be possible to salvage most of his fingers, but when he discovered that Dou could not pay for the operation, and had no insurance coverage--at least as far as he knew--the doctor performed a simple amputation. Dou's boss paid, but when Dou demanded compensation he was fired. did not have a labour contract, Dou says. Nor do I have the health insurance through my employer. No one would hire you here, if you insisted on having one. Dou comes from a peasant family in Shaoyu Town, Xihe County, in Chinas north-western Gansu Province and is one of Chinas estimated 200 million migrant workers. Health coverage should now improve for people like him. Just nine days after Dou started work in the zipper factory in April 2009, the government announced plans to provide universal access to essential health care to all residents in China by 2020. If fully implemented, the reform will spell the end of the market-based mechanisms that had been gradually introduced since the early 1980s; after 30 years of covering more than 90% of medical expenses for urban residents and providing basic, low-cost healthcare services to the rural population. The fact that Dou did not know if he had insurance coverage comes as no surprise to Wei Wei, the founder of Xiao Xiao Niao, a Beijing-based nongovernmental organization defending the few rights that migrant workers have. He says that migrant workers rarely know if they are insured and that this is partly why there are no reliable statistics on how many are covered. A survey carried out by the China Development Research Foundation back in 2000 revealed that fewer than 3% of migrant workers were covered by health insurance schemes, and those who were covered had only limited access to health-care services. Since then, the situation has improved somewhat. Now over 30 million migrant workers are covered by the Urban Employee Basic Health Insurance Scheme (URBMI), according to the Chinese Medical Insurance Association. As a result of Chinas 1978 economic reform, health-care coverage shrank dramatically. Among the rural population, it dropped to less than 10%. And even in the cities from the late 1970s to mid-1980s, people found themselves suddenly vulnerable as urban medical insurance ceased to cover the dependants of salaried workers and many workers were laid off owing to restructuring of state-owned enterprises in the early 1990s. The amount of health care that consumers had to pay for out of their own pockets rose sharply from just over 20% in 1980 to a high of 60% in 2000. Just as pernicious was the impact of reform on the supply side. Having previously benefited from state funding, hospitals suddenly had to survive on patient fees. Doctors at state-owned hospitals started prescribing medicines and treatment on the basis of their revenue-generating potential--both for themselves and the hospital--rather than for their clinical efficacy, a practice that continues today. [ILLUSTRATION OMITTED] Since 2003, the government has focused on two main types of insurance: the New Rural Cooperative Medical Schemes (NRCMS), which were initiated in 2003 for rural populations; and the URBMI, first piloted in 88 cities in 2007. These schemes are heavily subsidized with the government paying up to 80% of the premiums. According to Dr Lei Haichao, Director of Policy Research at the Ministry of Health, the NRCMS now covers 833 million of the rural population, while URBMI covers 337 million. …

The inability of traditional state organisations to respond to new economic, technological and social challenges and the associated emerging problems has made it necessary to adopt new methods of health management. As a result, new directions have emerged in the reform of Public Administration together with the introduction of innovative models. The aim is to achieve a type of management that focuses on results as well as on effort and efficiency. We intend to analyse to what extent the adoption of business management models by hospital healthcare units can improve their performance, mainly in terms of standards of efficiency. Data envelopment analysis (DEA) was used to investigate the efficiency of a set of public Portuguese hospitals. The aim was to evaluate the impact of business management in Portuguese public hospitals with regards to efficiency, specifically taking into account the fact that lack of resources and increased health care needs are a present and future reality. From a total of 83 public hospitals, a sample of 59 hospitals was chosen, of which 21 are state-owned hospital enterprises (SA) and 38 are traditional public administration sector hospitals (SPA). This study evaluates hospital performance by calculating two efficiency measures associated with two categories of inputs. The first efficiency measures the costs associated with hospital production lines and the number of beds (representing fixed capacity) as inputs. The annual costs generated by the hospitals in the consumption of capital and work (direct and indirect costs) are used. A second measure of efficiency is calculated separately. This measure includes in the inputs the number of beds as well as the human resources available (number of doctors, number of nurses and other personnel) in each hospital. With regard to output, the variables that best reflect the hospital services rendered were considered: number of inpatient days, patients discharged, outpatient visits, emergencies services, sessions in hospital day care services and the number of surgeries. The results seem to suggest that the introduction of market processes and changes in organisational structure--such as managerial autonomy and corporatisation of public hospitals--have had a positive impact on Portuguese public hospitals. This positive evolution was particularly evident in SA hospitals, but further studies are needed to confirm these preliminary results.

Objective To learn the organizational management competency of state-owned hospitals and their weakness, providing references for decision makers. Methods In the principle of stratified random sampling, 5 677 doctors in hospitals of different grades from 12 cities in Shandong Province, Hubei Province, Hebei Province and Inner Mongolia were investigated with questionnaires. Factor analysis is applied to extract factors. With results of this factor analysis, an evaluation model was built, followed by a fuzzy comprehensive evaluation on the management competency. Results The total satisfaction score on the organizational management by the doctors investigated is 3. 25, and those for system building and leadership behavior are respectively 2.88 and 3.20. Conclusions Organizational management of the public hospitals needs improving, especially development of hospital management systems and implementation. Key words: Doctors; Organizational management; Satisfaction; Factor analysis; Fuzzy comprehensive evaluation

Objective To understand current status and problems existed among clinicians workforce in several community health-care service centers of China to provide evidence for relevant policy-making. Methods Sixty-two community health-care service centers were selected from two districts each in Tianjin, Nanjing and Wuhan Cities, respectively, for the survey with questionnaire and focus group discussion. Results ①Fifty-eight of 62 community health-care service centers surveyed (93.5 percent) were qualified as a legal entity, 60 (96.8 percent) registered as medical insurance institutions designated by government, and 59 (95.2 percent) were state-owned or run by state-owned hospitals. All the 60 institutions provided service in public health and essential medical care for communities and were economically running relatively good. ②There were totally 1664 registered clinicians with an average age of 45 years ( and a standard deviation of 11 ), 942 of them ( 56.6 percent) at age above 45, 406 ( 24.4 percent) at age below 35, and 1166 (70.1 percent) with college education. ③Thirty-eight of 874 clinicians with medium or senior professional titles (4.4 percent) were qualified as general practitioners (GPs). ④Five hundred and thirty-eight of 1024 licensed clinicians or assistant clinicians (52.5 percent) were registered as internists for permit to practice medicine, and 65 registered as GPs (6.3 percent). There were totally 257 GPs in general practice clinics and 45 of them registered as GPs (17.5 percent) for permit to practice medicine. ⑤One hundred and five clinicians were promoted in the past three years and 17 of them were registered as GPs (16.2 percent). ⑥Three hundred and fifty-four clinicians were temporarily employed (21.3 percent) of those in service. Conclusions ①A lot of clinicians at general practice consultation rooms in community health-care service centers practiced medicine often beyond their duties registered. ②Few clinicians extended their willingness to be promoted as GPs, with too lower percentage of them taking promotion examinations. ③The number of GPs was in short obviously and quality of GPs was poor in general with their relatively older age.④It is suggested that more investment should be input, relevant policies perfected, attraction to GP position increased, human resource management and legal management of GPs strengthened, and non-registered practicing behavior should be eliminated by government. Key words: Community health center; Questionnaires; Interviews; General practitioner

Challenges and Progress of the Pediatric Cardiac Surgery in Shanghai Children's Medical Center: A 25-year Solid Collaboration With Project HOPE

This paper reports on a case study of the utilisation and users of cost information in a state‐owned teaching and research hospital in Australia. The findings indicate that the current utilisation of the cost information resides primarily at higher executive and managerial levels of the organisation. Organisational change, particularly pressure for improved productivity and competitiveness driven by public‐sector reforms in Australia, is significantly filtering down throughout the subject hospital. Various productive and unproductive ways that cost information is used, and impediments to the use of costing information in the hospital setting, are identified.

在激烈的市场竞争中,人才是医院竞争制胜的法宝,但传统的人力资源管理模式正面临挑战,已显示出力不从心之势.只有适应市场化环境,进行人力资本运作,采用这一新模式,医院才能走出困境,不断发展和壮大。

Factors influencing the return to work of patients after hip replacement and rehabilitation

In a State-Owned Hospital

Several large series of patients with acute myocardial infarction have been analyzed for factors which seemed important to prognosis. However, conclusions from these reports have been varied and at times conflicting. These results prompted us to study the hospital records of a group of patients with myocardial infarction by linear discriminant analysis utilizing high-speed computer equipment, seeking a key to the riddle of prognosis. This report presents the analysis of the study. It is a report on data accumulated from past clinical records. Only the method of analysis is the result of a carefully designed statistical experiment. Material and Methods Records of all patients with a diagnosis of acute myocardial infarction admitted between January, 1953, and January, 1960, to the University of Oklahoma Medical Center (including University Hospital, Veterans Administration Hospital, and Wesley Hospital) were reviewed. University Hospital is a state-owned teaching hospital which serves the State of Oklahoma on

MEDICAL EDUCATION IN EGYPT.