略论分层医疗卫生服务

略论分层医疗卫生服务李群良分层医疗卫生服务，是医疗卫生单位在保证绝大多数人的基本医疗卫生需求的前提下，放开非基本医疗卫生服务的价格，为社会不同层次的人群提供不同层次的医疗卫生服务，满足人民群众日益增长的对医疗卫生事业的不同需求。是卫生事业适应社会主义...     

广东省城镇医疗卫生资源现状分析及对策

本文从合理规划广东省城镇医疗卫生资源配置，充分发挥有限的医疗卫生资源的作用出发，探讨了我省医疗卫生资源的配置现状，对全省医疗卫生资源现状进行了理性分析，发现现有医疗卫生资源配置的种种不合理问题，对此提出了改革现有医疗卫生资源不合理配置的建议。     

落实管办职能，谈分和合才有意义

一个完整的医疗卫生系统至少包括医疗卫生筹资体系、医疗卫生服务体系、医疗卫生监督管理体系以及药品生产流通、医疗卫生人才培养等五个主要的子体系。北京大学李玲教授将这个体系比作一辆车，医疗卫生筹资体系和医疗卫生服务体系是车的两个轮子，而监督管理体系则是车的方向盘，是极为关键的部位。地市卫生局长们直指医疗卫生行政管理体制存在的问题，     

对我国医疗卫生体制改革的几点看法

1 要想实现经济和社会的协调发展，就必须大力推进医疗卫生事业发展，加快推进医疗卫生体制改革。应该说，怎么样强调医疗卫生事业的重要性都不过分，因为医疗卫生事业直接涉及到每个人的健康问题。一个全面协调发展的国家，其医疗卫生事业也应该是健康发展的，医疗卫生事业是社会协调发展的一个标志。     

试论市场经济条件下医疗卫生事业的多元化发展

在市场经济建立过程中，医疗卫生事业发展的现行基础和条件已经开始发生变化，决定和影响医疗卫生需求和供给的因素将会出现多元化和市场化的倾向。市场经济条件下医疗卫生事业多元化发展，是医疗卫生事业发展的内在要求，也是顺应市场经济变化的一种客观趋势。形成医疗卫生事业多元化的新格局，将有助于完善我国现行医疗卫生事业的结构，促进医疗卫生事业的发展；也有助于缓解局部地区存在的高质量的医疗卫生需求与一般服务供给的矛盾。     

医疗卫生单位提取物价变动补偿基金之我见

当前，我国市场经济发展迅速，“两个根本性”转变稳定推进，但医疗卫生体制改革却较为滞后，尤其是医疗卫生服务价格体制改革更显落后。如何使医疗卫生单位尽快适应社会主义市场经济的发展，经受市场物价涨幅的冲击，减少医疗卫生单位的亏损，笔者认为医疗卫生部门应借这...     

破除农村医疗卫生体制性障碍

建立具有中国特色的农村医疗卫生保健体系，必须破除农村医疗卫生体制性障碍，而破除农村医疗卫生体制性障碍，就必须分析目前农村医疗卫生体制的主要弊端，必须围绕提高农民健康水平，推进乡村卫生服务一体化，建立农村合作医疗制度来进行，必须以建立新型农村医疗卫生体制为突破口。     

医院和医疗保险的经济分析

本文试图从中观层面对医疗卫生服务市场进行初步分析，从卫生服务的供给方——医院着手，探讨医疗卫生市场失效的原因；从市场结构的角度来分析医疗保险组织在医疗卫生市场的作用，从而更加全面的理解和把握医疗卫生市场和医疗保险市场的运行机理，有助于从理论上把握医疗卫生体制改革的基础，更好地评估医疗卫生体制改革的效果，完善改革措施。     

继承和发展毛泽东医疗卫生保障思想

毛泽东医疗卫生保障思想和实践，继承、丰富和发展了马列主义社会保障理论，是对中国医疗卫生保障事业的重大贡献。笔者阐述了毛泽东医疗卫生保障思想五大理论精髓和五大实践经验，提出了坚持毛泽东医疗卫生保障思想，指导中国医疗卫生保障体制改革的若干意见。     

试论医患矛盾形成的原因与对策

医患矛盾是一种客观的社会现象，在我国当前社会和经济转型时期，医疗卫生体制改革引起资源重新配置和利益的再调整，人们思想观念还没有完全适应新的体制，同时医疗卫生领域中存在的一些不正常现象加剧了人们对医疗服务质量的不满和对医疗卫生体制改革的怀疑，造成医患关系紧张。医疗卫生体制改革应该进一步完善医疗卫生服务体系，坚持基本医疗卫生的公共产品定位，强化医疗卫生机构的服务意识，从而为市场经济体制的建立提供一个稳定和谐的社会环境。     

Crisis e independencia de las políticas de salud pública. Informe SESPAS 2014

Independence in the formulation of public health policies can be affected by various agents with objectives contrary to population health, such as large corporations. This lack of independence may be exacerbated by the economic crisis due to lower funding for health regulatory bodies or other measures designed to protect health. Large corporations have influenced the formulation of certain policies with an impact on health, such as those related to the tobacco industry, the chemical industry, nutrition, alcohol, pharmaceuticals, and health technology. The main areas in which these companies can influence policies are science, education, politics, and society in general. In this scenario, public health associations should take an active role in ensuring the independence of political decisions via actions such as the following: supporting strategies that guarantee the independence of public health policies and apply criteria of impartiality and transparency; rejecting those public-private partnerships launched to prevent health problems partly caused by these corporations; establishing partnerships to achieve independent training of health professionals and an institution with scientific authority in order to improve public health communication and counteract the lack of sound public health information; promoting a critical analysis of the definition of health problems and their solutions, and establishing related agendas (scientific, political and media) and alliances, so that continuing training for health professionals is independent.     

Labor adjustment in the Japanese health care industry: some empirical evidence

This paper examines the labor adjustment costs in the health care industry. Using Japanese data, we find that the cost of hiring new health care workers is the largest component of labor adjustment costs in the health care industry. Hence, it is difficult for employers in this industry to immediately increase the number of workers since this employment adjustment is extremely expensive.     

Can ??Giving Preference to My Patients?? be Explained as a Role Related Duty in Public Health Care Systems?

Most of us have two strong intuitions (or sets of intuitions) in relation to fairness in health care systems that are funded by public money, whether through taxation or compulsory insurance. The first intuition is that such a system has to treat patients (and other users) fairly, equitably, impartially, justly and without discrimination. The second intuition is that doctors, nurses and other health care professionals are allowed to, and may even in some cases be obligated to give preference to the interests of their particular patients or clients over the interests of other patients or clients of the system. These two intuitions are in potential conflict. One of the most obvious ways in which to ensure impartiality in a health care system is to require impartiality of all actors in the system, i.e. to give health care professionals a duty to treat everyone impartially and to deny them the ??right?? to give their patients preferential treatment. And one of the possible side-effects of allowing individual health care professionals to give preference to ??their clients?? is to create inequality in health care. This paper explores the conflict and proposes that it can be right to give preference to ??your?? patients in certain circumstances.     

推动健康消费 发展卫生产业的机遇与挑战

众所公认,计划经济体制下的卫生服务体系,办医模式,资源分配,资金筹措必须进行改革,尤其是医疗服务体制必须加速变革。由此而来,能否有可能在全面客观分析我国基本国情的前提下,充分利用我国已经全面推进医疗保险制度改革的有利条件,借鉴国有企业１０年改革的经验,紧跟教育产业的兴起,以推动健康消费为“契入口”,以加速医疗卫生体制为重点,积极主动,稳步有序推动和发展卫生产业。文章就有关健康消费发展卫生产业的概念     

医疗卫生工作与构建和谐社会若干问题的思考

做好医疗卫生工作是构建和谐社会的需要。因此，医疗卫生工作应以保障人民健康为目标，坚持以病人为中心的理念，关注医疗卫生服务的公平性，着眼于群体健康；把尊重劳动、尊重知识、尊重人才、尊重创造的方针落到实处；深化医疗卫生改革；加强医院文化建设，构建和谐的医患关系。     

中医养生保健服务机构监管问题研究

健康中国2030提出要加快养生保健服务发展,但我国养生保健产业尚在发展初期,相关立法、行业法规、政府监管处于缺失状态。当前的中医养生保健监管困境主要有中医养生保健监管缺乏立法保障,中医保健业务与中医治疗范围存在交叉难监管,没有统一的中医保健服务的行业标准、中医保健行业违规成本低、监管碎片化且缺乏实质服务监督。结合国内外监管经验,本文提出如下建议:加强政府对中医保健全过程监管,立法明确卫生监督主体及监管权责,甄别假伪信息、提升公众中医素养,发挥行业自律监督,创新多种政府主导的中医养生保健监管方式如网格化监管、分类管理、建立信誉体系、联合监管等。     

健康福利机制的跨学科研究述评

随着人们保健意识加强和健康产业的发展,国内外学术界对于健康问题的研究逐步从医学、生物学和健康学等自然科学向经济学等人文社会科学方向拓展,形成了人类健康领域的跨学科研究框架。通过收集、整理和分析近几年有关健康问题研究成果,发现健康产业正在以不同的方式转移和创造人的健康价值,产生了健康多元福利效应;并利用"健康周期"阐述健康研究的未来发展方向与研究思路。     

Improving health equity through health care systems research

Objective

To describe health equity research priorities for health care delivery systems and delineate a research and action agenda that generates evidence-based solutions to persistent racial and ethnic inequities in health outcomes.

Data Sources and Study Setting

This project was conducted as a component of the Agency for Healthcare Research and Quality's (AHRQ) stakeholder engaged process to develop an Equity Agenda and Action Plan to guide priority setting to advance health equity. Recommendations were developed and refined based on expert input, evidence review, and stakeholder engagement. Participating stakeholders included experts from academia, health care organizations, industry, and government.

Study Design

Expert group consensus, informed by stakeholder engagement and targeted evidence review.

Data Collection/Extraction Methods

Priority themes were derived iteratively through (1) brainstorming and idea reduction, (2) targeted evidence review of candidate themes, (3) determination of preliminary themes; (4) input on preliminary themes from stakeholders attending AHRQ's 2022 Health Equity Summit; and (5) and refinement of themes based on that input. The final set of research and action recommendations was determined by authors' consensus.

Principal Findings

Health care delivery systems have contributed to racial and ethnic disparities in health care. High quality research is needed to inform health care delivery systems approaches to undo systemic barriers and inequities. We identified six priority themes for research; (1) institutional leadership, culture, and workforce; (2) data-driven, culturally tailored care; (3) health equity targeted performance incentives; (4) health equity-informed approaches to health system consolidation and access; (5) whole person care; (6) and whole community investment. We also suggest cross-cutting themes regarding research workforce and research timelines.

Conclusions

As the nation's primary health services research agency, AHRQ can advance equitable delivery of health care by funding research and disseminating evidence to help transform the organization and delivery of health care.     

Is Home Health Care a Substitute for Hospital Care?

A previous study used aggregate (region-level) data to investigate whether home health care serves as a substitute for inpatient hospital care and concluded that “there is no evidence that services provided at home replace hospital services.” However, that study was based on a cross-section of regions observed at a single point of time and did not control for unobserved regional heterogeneity. In this article, state-level employment data are used to reexamine whether home health care serves as a substitute for inpatient hospital care. This analysis is based on longitudinal (panel) data—observations on states in two time periods—which enable the reduction or elimination of biases that arise from use of cross-sectional data. This study finds that states that had higher home health care employment growth during the period 1998–2008 tended to have lower hospital employment growth, controlling for changes in population. Moreover, states that had higher home health care payroll growth tended to have lower hospital payroll growth. The estimates indicate that the reduction in hospital payroll associated with a $1,000 increase in home health payroll is not less than $1,542, and may be as high as $2,315. This study does not find a significant relationship between growth in utilization of home health care and growth in utilization of nursing and residential care facilities. An important reason why home health care may serve as a substitute for hospital care is that the availability of home health care may allow patients to be discharged from the hospital earlier. Hospital discharge data from the Healthcare Cost and Utilization Project are used to test the hypothesis that use of home health care reduces the length of hospital stays. Major Diagnostic Categories with larger increases in the fraction of patients discharged to home health care tended to have larger declines in mean length of stay (LOS). Between 1998 and 2008, mean LOS declined by 4.1%, from 4.78 to 4.59 days. The estimates are consistent with the hypothesis that this was entirely due to the increase in the fraction of hospital patients discharged to home health care, from 6.4% in 1998 to 9.9% in 2008. The estimated reduction in 2008 hospital costs resulting from the rise in the fraction of hospital patients discharged to home health care may have been 36% larger than the increase in the payroll of the home health care industry.     

Traveling Abroad for Medical Care: U.S. Medical Tourists' Expectations and Perceptions of Service Quality

The SERVQUAL scale has been widely used to measure service quality in the health care industry. This research is the first study that used SERVQUAL to assess U.S. medical tourists' expectations and perceptions of the service quality of health care facilities located outside the United States. Based on a sample of U.S. consumers, who had traveled abroad for medical care, the results indicated that there were significant differences between U.S. medical tourists' perceived level of service provided and their expectations of the service that should be provided for four of the five dimensions of service quality. Reliability had the largest service quality gap followed by assurance, tangibles, and empathy. Responsiveness was the only dimension without a significantly different gap score. The study establishes a foundation for future research on service quality in the rapidly growing medical tourism industry.