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首页医学资讯Blog优质医学降低支出并提高满意度

降低支出并提高满意度

医疗支出不断攀升,医疗机构疲于调整;到底发生了什么变化,而这对病人来说意味着什么?

     保持卫生保健高质量的同时,控制卫生支出是当代卫生系统最突出的问题之一。世界各国都有他们自己的方式去尽力寻找这一问题的可持续解决方案。构思可能的答案和设计支出管理计划需要政府部门、保险公司和医疗机构后退一步并从宏观角度了解其卫生体系固有的复杂性。

 

      这个过程是重中之重,很重要的一点就是医疗机构包括医务工作者和保险机构要理解宏观改变与个体患者医疗之间的相互作用。这两个话题可能看似风马牛不相及,但是再仔细观察一下就会发现他们是如何相互依存的。

 

     住院时长就是这种尝试的一个主题,也是这种相互作用的精确演示。缩短手术病人和医疗住院病人的住院时间早已经是卫生体系的论述主题。住院病人的住院时长波动以多种方式影响着患者本人和医疗机构。

 

     从患者角度看,延长住院可以延长观察时间、及时发现并发症和减少再入院。但另一方面,延长住院增加了患者感染、血栓和压疮的风险,有些个案中,还助长了患者的依赖性,这种依赖性不必要地延长了康复时间。

 

      在这些顾虑中达到平衡不是一件容易的事,尤其是从医疗机构的角度。对医院来说,延长住院时间意味着拥挤的病房、加班加点的员工和医患比的降低。以上每一个因素都直接影响个体医疗的水平,以及病人监测和住宿条件等。

 

      认识到这种复杂性,医学界已经发展和适应处理这一核心问题。最明显的改变之一就是把治疗设置从住院到问诊的转变。对手术病人来说,这是通过微创手术实现的,例如骨科病人使用的关节镜、心脏科使用的经皮冠状动脉介入治疗、普外科的腹腔镜等。另外医疗护理上也可看到类似的努力,例如充血性心衰和慢性肾衰的门诊治疗,还体现在其他缩短住院时间的尝试上,以及把护理重担转移到门诊病人的设置。

 

      那么这些对普通病人来说意味着什么?在门诊接受治疗对很多人来说是极好的:不用承担住院带来的风险被禁锢在一张病床上,他们可以继续日常生活又不会影响收到的医疗质量。如前所述的手术技术也更小侵入性、更小创伤并且比开放手术的康复时间短的多。

 

      另一方面,这意味着获得专业医学帮助受限,以及后续监测可能是片段式的,这就把一些责任转移到了患者身上。案例管理和远程医疗服务认识到这一需求并已经通过定制服务来抵消风险和填补这一空白。包括由专业护士每天电话随访病人,专业医生与初级保健医生联络以保证医疗护理的平稳衔接和必要时快速获得专家意见。

 

     卫生保健是一个由患者需求、医疗机构、技术进步、文化偏好和经济实力组成的马赛克。每一片都包含一个困境和发展的世界。和任何马赛克一样,后退一步更开阔地端详其组成部分的相互作用,可以使我们更清楚地看到潜在的画面。

 

 

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