老龄化背景下社区老年人群对临终关怀的需求及对策研究

随着社会发展及人口老龄化,我国临终关怀服务的发展正在由传统的综合性医院内附设临终关怀病房向社区居家照料的临终关怀服务过渡,并呈多元化发展.文章分析社区临终关怀服务的发展现状,并提出我国临终关怀服务发展中存在的问题及相关对策研究,以推进我国临终关怀事业的发展.     

老龄化背景下我国临终关怀事业现状及对策

目的探讨老龄化背景下我国临终关怀事业的存在问题和促进对策。方法根据我国人口老龄化的现状和特点进行分析。结果分析了当前我国临终关怀事业存在的问题,从开展生死观教育、加强专业队伍培养、加大支持力度、探寻本土化模式等方面,提出了促进临终关怀事业发展的相应对策。结论应大力开展临终关怀事业以适应老龄化社会发展的需要。     

我国临终关怀发展中有关问题探讨

临终关怀是一门以临终病人生理、心理特征和临终照护实践规律为研究对象的新兴边缘学科,其目的在于使临终前病人的生命质量得到提高,减轻其肉体及精神上的痛苦,使其平静、舒适、无痛地度过人生的最后时光.根据我国国情改进临终关怀模式,改善伦理环境,加强政府支持和社会资助,有助于临终关怀事业在我国的发展.     

医护人员对临终关怀知识的调查

临终关怀是为各种疾病晚期的病人及其家属提供生理、心理和社会全面支持与照护的一种医疗保健服务，在我国尚处于初级发展阶段，医护人员只有在了解临终关怀概念、特点、意义、原则、工作内容，并掌握专业技术知识，改变传统医学观念，才能发展临终关怀事业，提高人的生命...     

临终关怀的伦理问题思考

目的 从伦理学的角度思考临终关怀事业在我国的发展。方法 伦理学分析。结果 了解临终关怀的历史沿革及我国独特的文化背景和伦理观念，提出临终关怀发展中的伦理问题，并寻找解决的办法。结论 加强死亡教育，迎接护理挑战，改善伦理环境，有助于临终关怀事业在我国的发展。     

安乐死与临终关怀的和谐统一

安乐死与临终关怀是两个不同的概念,二者既是对立又是统一的.文章通过对我国安乐死与临终关怀的分析指出,应积极推出安乐死方面的法律法规,同时高度重视并积极推进临终关怀制度,使二者和谐统一,使社会更加和谐.     

论我国临终关怀事业的发展与对策

论我国临终关怀事业的发展与对策张勘，黄品芳临终关怀学是一门新兴的学科，也是卫生保健中的新兴事物。１９６７年英国桑德斯博士首创圣克里斯多弗临终关怀医院迄今不过２７年时间，临终关怀机构已在不少国家得到发展和推广。现在美国已有２０００多所这类机构。我国专门...     

临终关怀的人文本质

开展临终关怀服务不仅是对人的尊严的维护，也是人道主义在医学领域内的升华和深化，更是全面适应现代医学模式要求的体现，标志着社会的发展与道德的进步。应大力加强临终关怀事业的发展，从而优化医疗卫生结构，不断提高医疗卫生服务的质量与效果。     

对临终患者实施医疗服务的实践与探讨

临终关怀是对无治愈希望病患的积极与整体性的照顾。通过成立以收治肿瘤晚期患者为 主的关爱病房，对临终患者实施医疗服务进行有益的尝试与探析，对发展临终关怀事业提出建议。     

农村居家照料老年病人临终关怀现状与对策

文中讨论我国现阶段农村老年临终患者临终关怀的发展现状,找出相关影响因素,并提出相应对策,根据我国国情适度开展临终关怀教育,提高全民认识;指导临终病人的照护者,推动家庭美德建设,促进临终关怀的实施,有助于我国临终关怀事业的发展。     

德国长期照护保险制度:缘起、规划、成效与反思

在人口老龄化加剧、长期照护需求增加、原有社会保障制度存在缺陷的背景下,德国在原有健康保险制度的基础上,于1994年推出了具有全民性与强制性、公私混合给付的长期照护保险运行模式。对长期照护保险关系、申请资格、给付条件、筹资机制等进行了详细规定。经过多年的运行和完善,长期照护保险在社会保险中的份额和贡献逐渐提升、投保人与受益群体不断扩大。但另一方面,在服务质量、申请条件和内容、筹资机制等方面仍面临许多争议。德国在完善社会保障体系、重视长期照护质量、完善筹资机制等方面积累的经验可以为我国长期照护保险制度的发展提供有益借鉴。     

建立农民健康保障制度

描述了我国农村合作医疗的现状，指出农村合作医疗因保障水平低、筹资困难及政府补偿不到位等原因，出现运行困难。因此，必须尽快建立农民健康保障制度。首先,要打破城乡二元社会保障结构，建立一种立足于当前国情的过渡性的目标模式；其次，建议开征保障税，将农民的健康保障纳入社会保障法体系，在不降低城市社会保障水平的前提下，促进农民的健康保障。     

The Mexican Social Security counterreform: pensions for profit.

The social security counterreform, initiated in 1997, forms part of the neoliberal reorganization of Mexican society. The reform implies a profound change in the guiding principles of social security, as the public model based on integrality, solidarity, and redistribution is replaced by a model based on private administration of funds and services, individualization of entitlement, and reduction of rights. Its economic purpose is to move social services and benefits into the direct sphere of private capital accumulation. Although these changes will involve the whole social security system--old-age and disability pensions, health care, child care, and workers' compensation--they are most immediately evident in the pension scheme. The pay-as-you-go scheme is being replaced by privately managed individual retirement accounts which especially favor the big financial groups. These groups are gaining control over huge amounts of capital, are authorized to charge a high commission, and run no financial risks. The privatization of the system requires decisive state intervention with a legal change and a sizable state subsidy (1 to 1.5 percent of GNP) over five decades. The supposed positive impact on economic growth and employment is uncertain. A review of the new law and of the estimates of future annuities reveals shrinking pension coverage and inadequate incomes from pensions.     

台湾地区长期照护体系述评及启示

通过分析台湾长期照护体系的特点和面临的挑战,提出了注重软环境的建设,让民众接纳并参与到长期照护事业中,达成社会共识;以减少社会震荡为原则,分步整合资源,从服务体系建设到保障制度建设;以老人需求为导向,设置适宜的照护服务模式;注重人才培养,贯彻“生物一心理一社会”医学模式的建议。     

我国贫困家庭儿童医疗保障制度研究：借鉴美国制度设计

随着经济社会发展,贫困家庭儿童医疗保障问题愈发受到重视。笔者从当前我国贫困家庭儿童医疗保障的发展现状入手,分析当前取得的成绩和存在的不足,并借鉴美国贫困家庭儿童医疗保障制度的经验,提出了完善我国贫困儿童医疗保障制度的措施：增强医疗保障意识、形成多元化筹资渠道、提高医疗保障水平以及构建医疗保障体系。     

新型农村合作医疗的制度创新探析

新型农村合作医疗制度不是传统农村合作医疗的简单恢复，而是在新的历史条件下结合现代社会保险理论和技术，对传统农村合作医疗进行改革、完善和创新。新型农村合作医疗具有传统的农村合作医疗制度无可比拟的优势，初具社会保障制度的雏形，成为中国农村社会医疗保障体系的重要组成部分。     

The relevance of unrelated costs internal and external to the healthcare sector to the outcome of a cost-comparison analysis of secondary prevention: the case of general colorectal cancer screening in the German population

The potential of secondary prevention measures, such as cancer screening, to produce cost savings in the healthcare sector is a controversial issue in healthcare economics. Potential savings are calculated by comparing treatment costs with the cost of a prevention program. When survivors’ subsequent unrelated health care costs are included in the calculation, however, the overall cost of disease prevention rises. What have not been studied to date are the secondary effects of fatal disease prevention measures on social security systems. From the perspective of a policy maker responsible for a social security system budget, it is not only future healthcare costs that are relevant for budgeting, but also changes in the contributions to, and expenditures from, statutory pension insurance and health insurance systems. An examination of the effect of longer life expectancies on these insurance systems can be justified by the fact that European social security systems are regulated by the state, and there is no clear separation between the financing of individual insurance systems due to cross-subsidisation. This paper looks at how the results of cost-comparison analyses vary depending on the inclusion or exclusion of future healthcare and non-healthcare costs, using the example of colorectal cancer screening in the German general population. In contrast to previous studies, not only are future unrelated medical costs considered, but also the effects on the social security system. If a German colorectal cancer screening program were implemented, and unrelated future medical care were excluded from the cost-benefit analysis, savings of up to €548 million per year would be expected. The screening program would, at the same time, generate costs in the healthcare sector as well as in the social security system of €2,037 million per year. Because the amount of future contributions and expenditures in the social security system depends on the age and gender of the recipients of the screening program (i.e. survivors of a typically fatal condition), the impact of age and gender on the results of a cost-comparison analysis of colorectal cancer screening are presented and discussed. Our study shows that colorectal cancer screening generates individual cost savings in the social security system up to a life expectancy of 60 years. Beyond that age, the balance between a recipient’s social security contributions and insurance system expenditure is negative. The paper clarifies the relevance of healthcare costs not related to the prevented disease to the economic evaluation of prevention programs, particularly in the case of fatal diseases such as colorectal cancer. The results of the study imply that, from an economic perspective, the participation of at-risk individuals in disease prevention programs should be promoted.     

Procedures and perceptions of professionals and groups acting in the Brazilian health plan market

This study analyzes the mechanisms used in Brazil by health plan and insurance operators, hospitals and physicians for organizing the access to health care services and their strategies towards cost reduction and decision-making. The study is based on the literature about regulation of the health services, with special focus on micro-management and managed care. From an intentional sample of health care organizations selected according to the number of beneficiaries, organizational modality and geographic criteria we selected probabilistic samples of doctors and hospital services. Data were collected through questionnaires applied to key informants from health care operators and affiliated doctors and hospitals. Results suggest that the relationships between health care organizations, physicians and hospitals follow basically patterns inherited from the former social security system, mainly with fixed pricing and open account payments. More complex financing mechanisms, risk sharing and efficiency strategies are of minor interest. Mechanisms for risk reduction and encouragement of adequate use of technologies are weak. Cost control is mainly based on co-payment and barriers to access to the services. We conclude that in Brazil managed care is still in its beginning.     

随军家属医疗保障制度改革思考

全军的医疗保障制度改革已经过去4年多时间,其中将原先的随军家属包干医疗改为优惠医疗的政策,在提高随军家属医疗保障的公平性和效率以及控制医疗消费的过快增长起到了积极作用。但是,在近几年的工作实践中,发现随军家属的保障模式仍然存在一些问题,军委、总部也要求加快后勤保障社会化部分,深化军队医疗保障制度改革。在此背景下,笔者提出了随军家属医疗保障制度改革的相关认识和思考,推进随军家属医疗保障社会化进程。     

Health insurance in Tunisia, current context and future perspectives

The Tunisian health system, notably in its health insurance component, has allowed to record a satisfactory evolution of health indicators. Nevertheless, socio-economic, demographic and epidemiological transitions impose a global reform of the system, notably of its financing. The present article, leaving from the presentation of the current system of coverage of the social security insured, analyses observed insufficiencies that have brought public authorities to commit the health insurance reform. The main observed insufficiencies refer to the multiplicity of regimes and their heterogeneity, generating iniquities between insured and a strong growth of care expenses financed directly by households. In addition, relationships of social security bodies with public and private providers of health care are little transparent, marked by a preferential processing of public structures, despite an important development of the private sector. In a second part, the author analyzes successively objectives of the health insurance reform of the social security regimes, its founder principles, characteristics of the proposed regime (a mandatory basic regime and an optional complementary regime) and sketches of providers payment methods.