本文選題：基本藥物制度　切入點(diǎn)：縣級公立醫(yī)院　出處：《安徽醫(yī)科大學(xué)》2017年碩士論文

【摘要】：背景2012年以來,在縣級公立醫(yī)院基本藥物制度和相關(guān)改革舉措不斷深入推進(jìn)的同時(shí),建立能夠突出功能定位和社會(huì)效益的縣級公立醫(yī)院績效考核制度已逐漸成為公立醫(yī)院改革的重要戰(zhàn)略任務(wù)之一。然而,目前以縣級公立醫(yī)院為評價(jià)對象,以公立醫(yī)院綜合改革成效考評為背景的綜合績效評價(jià)實(shí)證研究較少。因此,建立一套以公益性為核心,適合衛(wèi)生行政部門對公立醫(yī)院進(jìn)行監(jiān)管和考核、滿足多元化利益主體需求的績效評價(jià)體系,并運(yùn)用科學(xué)績效評價(jià)方法對縣級公立醫(yī)院開展績效評價(jià)顯得尤為必要和迫切。本研究旨在運(yùn)用前期構(gòu)建的績效評價(jià)指標(biāo)體系,對安徽省縣級公立醫(yī)院開展績效評價(jià)實(shí)證研究,了解縣級公立醫(yī)院改革前后醫(yī)院運(yùn)行和績效變化情況,發(fā)現(xiàn)各醫(yī)院發(fā)展優(yōu)勢和薄弱環(huán)節(jié),探討績效結(jié)果變化及相互間績效差異的原因,并提出針對性的對策建議,為進(jìn)一步完善縣級公立醫(yī)院績效評價(jià)工作以及衛(wèi)生行政部門科學(xué)決策提供參考和依據(jù)。方法采用文獻(xiàn)復(fù)習(xí)法和專家咨詢法,設(shè)計(jì)縣級公立醫(yī)院績效評價(jià)系列調(diào)查表和訪談提綱;采用現(xiàn)場調(diào)查法,在安徽省21個(gè)首批縣級公立醫(yī)院綜合改革試點(diǎn)縣中,根據(jù)地域分布,在皖南、皖中、皖北各隨機(jī)抽取4家(共12家)縣級公立綜合醫(yī)院作為調(diào)查現(xiàn)場,利用自行設(shè)計(jì)的調(diào)查問卷,對樣本醫(yī)院2011年和2015年相關(guān)數(shù)據(jù)進(jìn)行回顧性調(diào)查。采用Epidata 3.1、Excel對定量數(shù)據(jù)進(jìn)行雙錄入,使用SPSS16.0進(jìn)行數(shù)據(jù)分析。運(yùn)用構(gòu)成比、增長率等對12家醫(yī)院改革前后整體運(yùn)行指標(biāo)變化和各醫(yī)院2015年運(yùn)行現(xiàn)況進(jìn)行描述性分析;運(yùn)用加權(quán)TOPSIS法進(jìn)行各維度績效和綜合績效評價(jià)。結(jié)果(1)人力資源狀況:2015年,12家醫(yī)院職工總數(shù)為8637人,較2011年增長27.94%(年均增長率為6.35%);其中,衛(wèi)生技術(shù)人員、大專及以上、碩士及以上、高級職稱人員分別占82.19%、74.59%、1.54%、3.70%,較2011年分別增加0.93、10.66、0.99、0.07個(gè)百分點(diǎn),注冊護(hù)士數(shù)量及占比增幅較大,大專以上人員數(shù)量增長明顯,高素質(zhì)人員占比不足。醫(yī)護(hù)比、床護(hù)比分別為1:1.54和1:0.51,較2011年均略有增減。(2)醫(yī)療服務(wù)能力:2015年,12家醫(yī)院實(shí)際開放床位7041張,較2011年增長44.28%(年均增長率為9.60%)。醫(yī)療服務(wù)總量、門急診人次、出院人次分別為415.64萬人次、384.87萬人次、31.73萬人次,較2011分別增長69.64%、72.22%、47.24%,年均增長率分別為14.13%、14.56%、10.16%,門急診人次增速較快。(3)經(jīng)濟(jì)運(yùn)行狀況:2015年,12家醫(yī)院財(cái)政補(bǔ)助收入、醫(yī)療收入、藥品收入占總收入比例分別為7.17%、54.28%、35.81%,較2011年分別增長0.59、5.80和-7.55個(gè)百分點(diǎn),改革后,財(cái)政補(bǔ)助收入、醫(yī)療收入占總收入比例較改革前增加,藥品收入占比減低。2015年,醫(yī)療業(yè)務(wù)成本、管理費(fèi)用支出、財(cái)政項(xiàng)目支出占總支出比例分別為84.48%、12.32%、2.76%,分別較2011年降低1.26、2.02、0.39個(gè)百分點(diǎn),藥品費(fèi)用占比由41.88%降低為36.71%,降低5.17個(gè)百分點(diǎn),改革后藥品費(fèi)用占比變化較大。2015年,總收支結(jié)余較2011年有所增加,增幅為22.18%;業(yè)務(wù)收支結(jié)余較2011年顯著降低,降幅為86.87%;財(cái)政補(bǔ)償收支結(jié)余較2011年明顯增加,增長率為132.20%。(4)患者為中心維度:2015年,各醫(yī)院均建立了醫(yī)患溝通制度、醫(yī)療服務(wù)流程制度。住院患者滿意度為96.12%,較2011年提高1.72個(gè)百分點(diǎn)。術(shù)前平均待床日為2.29床日,較2011年增加0.11床日;10分鐘內(nèi)急會(huì)診反映達(dá)標(biāo)率均保持在99.0%以上,醫(yī)療服務(wù)可及性尚可。(5)公益性為導(dǎo)向維度:2015年,次均門診費(fèi)用206.89元,較上年增長率為3.52%,其中次均門診藥品費(fèi)用占42.78%,較2011年降低2.54個(gè)百分點(diǎn);次均住院費(fèi)用4943.49元,較上年增長率為7.32%,其中次均住院藥品費(fèi)用占38.21%,較2011年降低9.91個(gè)百分點(diǎn)。2015年,城鎮(zhèn)職工住院患者補(bǔ)償比為78.63%,較2011年降低0.56個(gè)百分點(diǎn),變化幅度微小;城鄉(xiāng)居民住院患者補(bǔ)償比為61.46%,較2011年增加5.30個(gè)百分點(diǎn),增幅較大。2015年,國家基本藥物配備率為50.13%,較上年增長7.43個(gè)百分點(diǎn),國家基本藥物采購金額比例19.73%;帶量采購實(shí)施后,政策性虧損得以充分彌補(bǔ),絕大多數(shù)藥品也能及時(shí)供應(yīng)。(6)醫(yī)療質(zhì)量與安全維度:診斷、治療、護(hù)理、醫(yī)院感染、安全管理方面,絕大多數(shù)指標(biāo)均控制在較好水平,且符合綜合醫(yī)院管理標(biāo)準(zhǔn),但部分核心指標(biāo)控制仍不理想。2015年,剖宮產(chǎn)率由2011年55.11%降低至2015年49.64%,護(hù)理文書書寫合格率由95.68%增至97.17%,建立重點(diǎn)藥品監(jiān)控制度的醫(yī)院數(shù)量由4家增至9家;住院患者抗菌藥物使用率由71.93%降低至62.04%;Ⅰ類切口手術(shù)患者預(yù)防性使用抗菌藥物比例降低至76.22%(降7.43個(gè)百分點(diǎn)),手衛(wèi)生依從率由42.88%增至57.09%,以上指標(biāo)仍未達(dá)到相關(guān)管理標(biāo)準(zhǔn)。(7)效率與效益維度:2015年,人員支出占總支出比例為30.54%,比2011年增長6.22個(gè)百分點(diǎn);平均每職工年業(yè)務(wù)收入為28.21萬元,比2011年增長8.82萬元。管理費(fèi)用占總支出比例由14.35%降低至12.32%;業(yè)務(wù)收支結(jié)余率降低明顯,2015年為0.28%,較2011年降低3.68個(gè)百分點(diǎn);資產(chǎn)收益率、凈資產(chǎn)收益率有所下降,分別由5.24%降至3.39%、8.45%將至12.43%,改革后資產(chǎn)收益能力略有降低。醫(yī)師人均每日負(fù)擔(dān)住院床日為2.70床日,較2011年增加0.18床日;醫(yī)師人均每日負(fù)擔(dān)診療人次數(shù)有所增加,由4.90人次增至6.55人次,表明工作效率提高,工作負(fù)荷增大。2015年,4家醫(yī)院床位處于高效率運(yùn)行狀態(tài),8家處于低效率運(yùn)行狀態(tài)。(8)員工維度:2015年,職工教育(培訓(xùn))投入占業(yè)務(wù)收入比例0.14%,較2011年下降0.07個(gè)百分點(diǎn),職工教育(培訓(xùn))投入嚴(yán)重不足。醫(yī)護(hù)進(jìn)修人員比例3.52%,較2011年增長0.75個(gè)百分點(diǎn),進(jìn)修人員不足。2015年醫(yī)護(hù)人員滿意度92.68%,較2011年增加0.30個(gè)百分點(diǎn)。(9)醫(yī)院發(fā)展維度:2015年農(nóng)合患者出院人次占縣域內(nèi)出院人次比例35.07%,較2011年增長5.17個(gè)百分點(diǎn),改革后縣域醫(yī)療服務(wù)能力有所提升;市級及以上重點(diǎn)學(xué)科、特色�？茢�(shù)13個(gè),較2011年增加10個(gè),改革后重點(diǎn)學(xué)科、特色�？平ㄔO(shè)得以加強(qiáng)。2015年政府投入占醫(yī)院總支出比例7.53%,較2011年增加0.41個(gè)百分點(diǎn),政府投入增量不足;凈資產(chǎn)增長率13.77%,較2011年降低6.21個(gè)百分點(diǎn),改革后凈資產(chǎn)有所減少;資產(chǎn)負(fù)債率44.60%,較2011年增加4.05個(gè)百分點(diǎn)(2012年為51.86%),改革后資產(chǎn)負(fù)債率高于改革前,但呈降低趨勢;業(yè)務(wù)收入增長率10.06%,較2011年降低7.07個(gè)百分點(diǎn),改革后業(yè)務(wù)收入增速減緩。2015年信息化建設(shè)和利用度69.05%,較2011年增加54.76個(gè)百分點(diǎn),信息化服務(wù)能力增強(qiáng)。(10)綜合績效評價(jià):2015年綜合績效值明顯高于2011年,縣級公立醫(yī)院改革成效得以體現(xiàn)。公益性為導(dǎo)向、質(zhì)量與安全、效率與效益、發(fā)展4個(gè)維度績效值均高于改革前,而患者為中心、員工2個(gè)維度績效值低于改革前。2015年,D醫(yī)院綜合績效最高,G醫(yī)院次之,J醫(yī)院最低,除前2名外,其它各醫(yī)院之間績效差異較小。結(jié)論(1)服務(wù)能力得以提升,但縣域服務(wù)總量仍不高(2)衛(wèi)生人力資源總量增加,但優(yōu)質(zhì)資源缺乏,結(jié)構(gòu)不合理(3)醫(yī)院經(jīng)濟(jì)運(yùn)行總體平穩(wěn),收支結(jié)構(gòu)發(fā)生改變,但政府投入依舊不足(4)醫(yī)藥費(fèi)用上漲得以控制,但患者整體費(fèi)用獲益感并不明顯(5)藥品采購機(jī)制初步建立,仍需進(jìn)一步細(xì)化(6)醫(yī)療質(zhì)量與安全總體良好,管理機(jī)制有待完善(7)床位工作效率有待改善(8)員工待遇條件得以改善,但積極性提升制約因素依然存在(9)績效評價(jià)指標(biāo)體系及方法可操作性強(qiáng),需進(jìn)一步深入研討建議(1)加強(qiáng)縣域醫(yī)療衛(wèi)生服務(wù)體系規(guī)劃,促進(jìn)醫(yī)院健康發(fā)展(2)完善政府投入機(jī)制,保障公益性落實(shí)(3)合理調(diào)整醫(yī)療服務(wù)價(jià)格,體現(xiàn)醫(yī)務(wù)人員價(jià)值(4)改革醫(yī)保支付方式,增強(qiáng)醫(yī)保杠桿作用(5)加強(qiáng)醫(yī)院自我管理,提高自我補(bǔ)償能力(6)完善人事與薪酬分配制度,提高人員積極性(7)改善患者就醫(yī)感受,提高患者滿意度(8)加強(qiáng)醫(yī)療質(zhì)量管理,保障醫(yī)療安全(9)加強(qiáng)信息化建設(shè),提高醫(yī)院管理效率(10)完善績效評機(jī)制,提高績效評價(jià)效能
[Abstract]:Background since 2012, in the county public hospital system of basic drugs and related measures to promote the deepening of reform and the establishment of performance appraisal system of public hospitals in the county can highlight the function and social benefits has gradually become an important strategic task of the reform of public hospitals. However, the current county public hospital as the evaluation object, the evaluation results of comprehensive the reform of public hospital comprehensive performance evaluation of the background of empirical research is limited. Therefore, to establish a set of public welfare as the core, for the public health administrative departments for supervision and assessment of public hospital performance evaluation system, to meet the demand of diversification of interests, and use the scientific method of performance evaluation of public hospitals in the county to carry out performance evaluation is particularly necessary and urgent the purpose of this study is to use pre construction. The performance evaluation index system of the county public hospital of Anhui Province, the development of performance An empirical study on the efficiency evaluation, understand the change of hospital operation and performance before and after the reform of public hospitals in the county, the hospital found that the development of advantages and weaknesses, to explore the causes of changes and differences between the performance of performance results, and put forward the countermeasures and suggestions, and provide reference for the further improvement of the performance evaluation of public hospitals at the county level and the administrative department of health scientific decision-making. Methods by means of literature review and expert consultation, design of county public hospital performance evaluation questionnaire and interview outline series; through the survey, in Anhui Province, the first batch of 21 County Comprehensive Reform of public hospitals in the county, according to geographical distribution, in Anhui, Anhui, Anhui were randomly selected 4 (total 12) the county public hospital as the investigation site, using a self-designed questionnaire, the sample hospitals in 2011 and 2015 data were retrospectively The survey by Epidata. 3.1, Excel double entry of data, data were analyzed using SPSS16.0. The constituent ratio, growth rate of change of operation index before and after the reform of 12 hospitals in the whole and the operation situation of the hospital in 2015 were analyzed with weighted TOPSIS method; the dimensions of performance and comprehensive performance evaluation results (1). Human resources: 2015, 12 hospitals and 8637 employees, an increase of 27.94% compared to 2011 (the average annual growth rate of 6.35%); among them, health professionals, college degree or above, master degree or above, senior professional titles accounted for 82.19%, 74.59%, 1.54%, 3.70%, compared to 2011 increased by 0.93,10.66,0.99,0.07 percentage points, registered nurses the number and proportion of the larger increase in number of college personnel increased significantly, high-quality personnel accounted for less than. The ratio of doctors to nurses and nursing bed were 1:1.54 and 1 respectively.:0.51, a slight increase or decrease (at an average annual rate of 2011. 2) the ability of medical services: 2015, 12 hospitals with 7041 beds, an increase of 44.28% compared to 2011 (the average annual growth rate of 9.60%). The total amount of medical services, outpatient, hospital visits were 4 million 156 thousand and 400 passengers, 3 million 848 thousand and 700 passengers, 317 thousand and 300 passengers, compared with 2011 growth of 69.64%, 72.22%, 47.24%, the average annual growth rate were 14.13%, 14.56%, 10.16%, outpatient rapid growth. (3) the economic situation: in 2015, 12 hospitals financial subsidy income, medical income, drug income total income ratio was 7.17%, 54.28%, 35.81%, compared with 2011 growth of 0.59,5.80 and -7.55 percentage points, respectively, after the reform, the financial subsidy income. The medical income total income ratio increased compared to before the reform, the proportion of drug income decreased.2015 years, medical service costs, management costs, financial expenditure total expenditure ratio were 84.48%, 12.32%, 2.76%, respectively, compared with 2011 down Low 1.26,2.02,0.39 percentage points, the proportion of drug costs decreased from 41.88% to 36.71%, 5.17 percentage points lower, after the reform of drug costs accounted for large changes in.2015 years, the total balance of payments increased in 2011, an increase of 22.18%; the balance of business than in 2011 decreased significantly, a decline of 86.87%; the balance of financial compensation than in 2011 increased significantly the growth rate of 132.20%. (4) patients as the center dimension: 2015, hospitals have established the system of doctor-patient communication, medical service process system. The satisfaction rate of hospitalized patients was 96.12%, compared to 2011 increased 1.72 percentage points. The average preoperative stay for 2.29 days on the bed bed, an increase of 0.11 compared to 2011 on the bed; 10 minutes call consultation reflect the compliance rate remained above 99%, accessibility of medical services is acceptable. (5) public welfare oriented dimensions: in 2015, the average outpatient expenses of 206.89 yuan, representing a growth rate of 3.52%, the average outpatient drug Costs accounted for 42.78%, 2.54 percentage points lower than in 2011; the average hospitalization cost of 4943.49 yuan, representing a growth rate of 7.32%, the average hospitalization expenses of drugs accounted for 38.21%, 9.91 percentage points lower than in 2011.2015 years, urban workers hospitalized patients compensation ratio of 78.63%, 0.56 percentage points lower than in 2011, small changes; urban and rural areas residents of inpatient compensation ratio of 61.46%, an increase of 5.30 percentage points higher than in 2011, a larger increase in.2015 years, the national basic drugs with rate of 50.13%, an increase of 7.43 percentage points over the previous year, the national essential drug procurement amount than in 19.73% cases; with the amount of purchase after the implementation of the policy to fully compensate for the loss, the vast majority of drugs can also be timely supply. (6) the dimension of medical quality and safety: the hospital diagnosis, treatment, nursing, infection, safety management, most indicators are controlled in a better level, and in accordance with the hospital management standard, but Part of the core control index is still not ideal for.2015 years, the cesarean section rate decreased from 55.11% in 2011 to 49.64% in 2015, nursing documents writing qualified rate increased from 95.68% to 97.17%, the number of the establishment of key drug monitoring system in hospital from 4 to 9; the rate of hospitalization decreased from 71.93% to 62.04%, the use of antibiotics in patients with type I; preventive use of antimicrobial the drug ratio is reduced to 76.22% incision surgical patients (down 7.43 percentage points), hand hygiene compliance rate increased from 42.88% to 57.09%, the above index has not yet reached the relevant standards of management. (7) the efficiency and effectiveness of dimensions: 2015, staff expenditure accounted for the proportion of total expenditure was 30.54%, up 6.22 percentage points higher than in 2011; average revenue per employee the year was 282 thousand and 100 yuan, up 88 thousand and 200 yuan more than in 2011. Management costs accounted for the proportion of total expenditure decreased from 14.35% to 12.32%; the business balance rate was decreased to 0.28% in 2015, compared to 2011 decreased by 3.68 %; return on assets, net assets yield decreased, respectively from 5.24% to 3.39%, 8.45% to 12.43%, asset profitability decreased slightly after the reform. The physician daily burden of hospital beds per capita, 2.70 bed, 0.18 bed days increase compared to 2011; physicians per capita daily burden of treatment times increased by 4.90 times to 6.55 people, shows that the work efficiency is improved, the work load increases.2015 years, 4 hospital beds in a state of high efficiency operation, 8 in a low efficiency state. (8) employees: 2015, employee education (training) investment proportion of business income of 0.14%, down 0.07 percentage points compared with 2011, the staff education (training) a serious shortage of investment in education. Medical staff ratio of 3.52%, an increase of 0.75 percentage points compared to 2011, for lack of staff.2015 staff satisfaction 92.68%, an increase of 0.30 percentage points compared to 2011. (9) the hospital development dimension: 2015 agricultural discharges within the county hospital patients accounted for 35.07% of the proportion of passengers, an increase of 5.17 percentage points compared to 2011, after the reform of county medical service ability increased; the municipal level and above key disciplines, the specialty of the number 13, increased 10 compared with 2011, after the reform of the specialty construction of key disciplines, to strengthen government investment for hospital.2015 a proportion of 7.53%, an increase of 0.41 percentage points higher than in 2011, the government investment increment is insufficient; the growth rate of net assets of 13.77%, 6.21 percentage points lower than in 2011, after the reform of the net assets decreased; asset liability ratio of 44.60%, an increase of 4.05 percentage points compared to 2011 (51.86% in 2012), after the reform of the balance is higher than before the reform, but decreased; the business income growth rate of 10.06%, 7.07 percentage points lower than in 2011, after the reform of business revenue growth slowed.2015 years of information construction and utilization of 69.05%, compared with 2011. Plus 54.76 percentage points, to enhance the competence of informatization service. (10) a comprehensive performance evaluation: comprehensive performance in 2015 was significantly higher than that in 2011, the effectiveness of the county public hospital reform reflected public welfare oriented, quality and safety, efficiency and benefit, the development of the 4 dimensions of performance value is higher than before the reform, while the patients as the center, staff the 2 dimensions of performance is lower than before the reform of.2015 years, D hospital comprehensive performance is highest, G times in the hospital, J hospital, in addition to the lowest, outside the top 2, between the hospital performance were smaller. Conclusion (1) the service ability can be improved, but the service is still not high (2) the total amount of health manpower resource increase, but the quality of the lack of resources, the unreasonable structure of the hospital (3) the economy is generally stable, balance of payments structure changed, but the government investment is still insufficient (4) the rise of medical expenses can be controlled, but the overall cost of patients benefit sense is not obvious (5) drug procurement mechanism Step up, still need further refinement (6) medical quality and safety is generally good, needs to improve management mechanism (7) beds efficiency needs to be improved (8) conditions to improve the treatment of employees, but to enhance motivation constraints still exist (9) evaluation index system and method of performance, strong operability, need further study suggestions (1) to strengthen the county health service system planning, and promote the healthy development of the hospital (2) to improve the government investment mechanism, to protect the public welfare implement (3) adjust the prices of medical service, embody the value of the medical staff (4) Medicare payment reform, strengthen Medicare leverage (5) to strengthen the hospital self management, to improve the self compensation (6) to improve the ability of personnel and salary distribution system, improve the enthusiasm of staff (7) to improve the patient's medical experience, improve patient satisfaction (8) to strengthen the medical quality management, ensure medical safety (9) to strengthen the construction of information technology, improve Hospital management efficiency (10) improving performance evaluation mechanism and improving performance evaluation efficiency

【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R197.3

【參考文獻(xiàn)】

相關(guān)期刊論文 前10條

1 王珩;趙允伍;徐舒曼;李念念;卞城;尹紅燕;王存慧;;公立醫(yī)院績效評價(jià)問題與對策探討[J];衛(wèi)生經(jīng)濟(jì)研究;2016年10期

2 韓曉梅;劉志云;阿布都沙拉木·依米提;;效率指數(shù)模型在腫瘤醫(yī)院床位工作效率評價(jià)中的應(yīng)用[J];現(xiàn)代預(yù)防醫(yī)學(xué);2016年11期

3 曹學(xué)平;;安徽藥品:最低價(jià)中標(biāo)品種出局——安徽藥品“帶量采購”亂象調(diào)查[J];中國招標(biāo);2015年32期

4 李新偉;;基于平衡計(jì)分卡的公立醫(yī)院績效評價(jià)指標(biāo)體系研究[J];中國現(xiàn)代醫(yī)藥雜志;2015年01期

5 李蕊;劉建;;多種方法構(gòu)建北京地區(qū)三甲醫(yī)院績效評價(jià)推薦指標(biāo)的應(yīng)用·衛(wèi)生論壇·[J];繼續(xù)醫(yī)學(xué)教育;2014年03期

6 鄒雄;李連鳳;周東華;貝為武;;四種綜合評價(jià)方法在廣西某三級甲等醫(yī)院科研績效評價(jià)中的應(yīng)用[J];醫(yī)學(xué)與社會(huì);2013年11期

7 郭永瑾;朱燕剛;羅力;舒蝶;;以公益為核心的公立醫(yī)院績效考核指標(biāo)體系構(gòu)建研究[J];解放軍醫(yī)院管理雜志;2013年05期

8 李春暉;方龍;胡靖琛;葛陽;姚聰;宇傳華;;公立醫(yī)院績效評價(jià)指標(biāo)體系及應(yīng)用[J];中國衛(wèi)生統(tǒng)計(jì);2013年02期

9 周文煜;;我國公立醫(yī)院績效評價(jià)體系構(gòu)建研究[J];對外經(jīng)貿(mào);2013年04期

10 孫紐云;梁銘會(huì);;美國醫(yī)療服務(wù)績效評價(jià)體系的循證研究及對我國的啟示[J];中國循證醫(yī)學(xué)雜志;2012年04期

相關(guān)博士學(xué)位論文 前2條

1 亓慧;基于卓越績效準(zhǔn)則的公立醫(yī)院績效評價(jià)研究[D];山東大學(xué);2014年

2 董四平;縣級綜合醫(yī)院規(guī)模經(jīng)濟(jì)效率及其影響因素研究[D];華中科技大學(xué);2010年

相關(guān)碩士學(xué)位論文 前10條

1 卞城;醫(yī)改背景下的縣級醫(yī)療機(jī)構(gòu)績效評價(jià)指標(biāo)體系研究[D];安徽醫(yī)科大學(xué);2016年

2 胡玲;基于平衡計(jì)分卡的公立醫(yī)院財(cái)務(wù)績效評價(jià)體系構(gòu)建研究[D];西北大學(xué);2015年

3 許海弦;山東省縣級公立醫(yī)院改革試點(diǎn)醫(yī)院運(yùn)行情況分析[D];山東大學(xué);2015年

4 鄧璐;上海公立醫(yī)院的補(bǔ)償機(jī)制研究[D];華東理工大學(xué);2015年

5 徐舒曼;安徽省縣級醫(yī)院實(shí)施基本藥物制度效果研究[D];安徽醫(yī)科大學(xué);2014年

6 李艷妮;山東省縣級醫(yī)院發(fā)展現(xiàn)狀研究及效率評價(jià)[D];青島大學(xué);2013年

7 楊茜;新醫(yī)改形勢下公立醫(yī)院補(bǔ)償機(jī)制改革問題研究[D];天津師范大學(xué);2012年

8 鄭見立;公立醫(yī)院績效考核指標(biāo)體系及評價(jià)系統(tǒng)設(shè)計(jì)[D];華中科技大學(xué);2012年

9 方龍;公立醫(yī)院績效綜合評價(jià)方法及其在13所醫(yī)院評價(jià)中的應(yīng)用[D];華中科技大學(xué);2011年

10 許守剛;2006—2008年全國23所大型公立醫(yī)院的發(fā)展與效率研究[D];山東大學(xué);2010年

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