公立医院利益相关者的利益协调困境及共同治理路径选择

公立医院的利益相关者众多,利益诉求存在差异,而且只有少数利益相关者处于主导地位,非均衡博弈不利于公益性的实现。公立医院利益相关者的利益均衡需要建立良好的利益协调机制,保证各利益相关者利益的有效实现。公立医院的利益协调不是通过政府、市场或社会单方面可以实现的,需要整合各方力量,优势互补,有必要建立利益相关者共同治理机制,实现利益的整合和协调。     

我国突发公共卫生事件应急管理模式变革——《美国州卫生应急授权示范法》的借鉴与启示

我国应急管理模式出现了由单边治理到利益相关者共同治理的变革趋势,随着管理模式的变革,应急立法的权义结构在坚持以体现公共利益的国家权力一公民义务为基本结构,秉承公共利益优先原则的基础上,需要更加重视利益相关者的权利。建议借鉴《美国州卫生应急授权示范法》,完善我国《突发公共卫生事件应急条例》,在其权义结构设计中加入利益相关者的权益保护制度,尤其要重视利益相关者的人身自由权和隐私权保障,赋予利益相关者侵权责任豁免权和获得国家补偿的权利。     

新医改政策中“公益性”价值取向的伦理辨析

新医改政策中,"会益性"的价值取向有待于理论澄清.医疗卫生的公益性只能以社会公共利益为目的,不能有"营利、生存和发展"的目的.在既定医疗卫生体制下,公立医疗机构难以回归会益性.建议调整现行医疗卫生的会益性政策:各级政府才是医疗卫生会益性的责任主体,而非公立医院.     

基于利益相关者理论的医师多点执业损益分析

为有效协调医师多点执业政策推行中各利益相关主体的主观动机和实际行为,促进医师多点执业政策的进一步发展,通过专家访谈,在明晰确定的利益相关者、预期的利益相关者、潜在的利益相关者的利益诉求、政策影响力、政策执行意愿后,对其进行损益情况分析。据此提出发展医师多点执业政策的建议:健全医师多点执业的保障性机制是前提,卫生行政部门的简政放权是关键,完善的绩效考核体系和薪酬体系是动力,推动公立医院的公益性改革是保障。     

公立医院治理体系中利益相关者的界定及其行为模式分析

构建公立医院利益相关者治理模式,首先有两个基础性的工作.一是识别利益相关者,即明确哪些人群或者组织是公立医院的利益相关者;二是对各利益相关者的属性和行为模式进行分析,因为"我们必须以各利益相关者的责、权、利为基础,把个体行为作为研究公司组织的逻辑出发点."[1]     

社区卫生服务机构实行收支两条线管理的利益相关者分析

利用利益相关者理论分析社区卫生服务机构实行收支两条线管理的各方利益者.其中主要利益相关者是社区居民、社区卫生服务机构及其医务人员,次要利益相关者是地方政府和卫生主管部门,外部利益相关者是医保部门和药商.通过对各方利益者的深入分析,提出了政策实施中应注意的关键问题.     

基于利益相关者分析的湖北省贫困县“两癌”免费检查管理模式研究

目的通过对湖北省29个贫困县"两癌"免费检查项目实施中各利益相关者进行分析,探讨更为长效的"两癌"检查管理模式。方法采用定性和定量相结合的方法收集数据,运用利益相关者理论进行分析,并采取米切尔评分法将各利益相关者分为3类。结果决定型利益相关者中,各级管理部门应加强各方组织、协调,适龄农村妇女应提高健康和自我保护意识。预期型利益相关者中,医疗机构应提高其检查和服务水平,保障部门应及时拨款并建立完善的后续救助体系。潜在型利益相关者中,亲属应更关注亲人健康,媒体应加强宣传。结论 "两癌"检查需因地制宜制定应对策略,但管理部门也应把握各利益相关者的动态变化,以期实现项目的长效运转。     

基于利益相关者理论的中医院发展政策研究

目的:了解中医院发展政策的核心利益相关者.方法:基于利益相关者理论运用循证医学的方法和德尔菲咨询法,按照米切尔评分标准,通过SPSS13.0软件分析.结果:综合评分在3.0以上的为中医院发展的核心利益相关者,确定了7个中医院核心利益相关者,并从对中医院发展政策的角色,优势/劣势,实施意愿、实施能力和实施对策5个方面进行分析.结论:中医院发展政策应该权衡各利益相关者的利益.     

医联体建设中的利益协调困境及协同治理机制研究

医联体利益相关者的利益协调存在价值理念缺失、制度设计缺陷和适宜治理机制缺乏等困境,其根源在于利益相关者系统的复杂性和系统性,协同治理强调治理主体的多元协同并组成利益共同体,各利益相关者互相配合和协调,共同进步以达到协同治理优势。研究建立了医联体利益相关者协同治理综合分析理论框架,并提出了协同治理的价值认同机制、行为合作机制和利益共享机制,达到医联体组织建设公共价值增溢效应的目的。     

电子健康档案建设中的利益相关者分析

通过利益相关者理论分析电子健康档案建设中的利益相关者.主要利益相关者是居民、卫生行政部门、基层医疗卫生机构、医务人员、软件供应商,次要利益相关者是公共卫生专业机构、财政部门、其他相关行政部门和第三方.通过分析,提出推进电子健康档案建设的对策建议.     

Ethics Review for Sale? Conflict of Interest and Commercial Research Review Boards

Research review boards, established to protect the rights and welfare of human research subjects, have to ensure that conflicts of interest do not interfere with the ethical conduct of medical research. Private, commercial review boards, which increasingly review research protocols, are themselves affected by a structural conflict of interest. Within the regulatory setting, procedural conflict-of-interest rules are essential because of the absence of clear substantive rules in research review and the reliance on the fairness and good judgment of institutional review board members. Current guidelines and regulations lack adequate conflict-of-interest rules and provide insufficient details on the substantive rules. Because commercial review boards are similar to administrative courts and tribunals, rules of administrative law on bias are applied to determine when a conflict of interest jeopardizes the purposes of research review; administrative law has always judged financial conflicts of interest severely. The structure of private review tends to breach a core principle of administrative law and procedural justice. Reform of the research review system will reinforce public trust in the process.     

Civil society? What deliberative democrats can tell advocates about how to build public commitment to the health promotion agenda

Closing the health inequity gap can be seen as an issue of justice, however what concretely best serves the interest of justice is in dispute. It is argued that standard policy-making mechanisms are inadequate to address this issue, and therefore more and better public dialogue is required. Drawing on deliberative democratic theory and practice, three public organizing considerations are offered: organizing within the state sphere, organizing within the public sphere, and using cross strategies. It is recommended that public resources be provided to involve the public in deliberations about population health promotion issues related to the wicked problem of health inequities.     

An analysis of public-interest group positions on radiation protection

The history of radiation risk management is replete with contentious public debate between public interest groups and the technical community of radiation protection professionals. To promote a deeper understanding of this phenomenon, this paper describes the rationales and values underlying public-interest group positions in one radiation risk domain (low-level waste) and contrasts them with those of the technical community. Public interest group objections to recycling of radioactivity-contaminated materials and to discarding of other low-level wastes are made on fairness, risk assessment, and energy-policy grounds. Concerns about procedural fairness stem from the continuing use of top-down expert-driven, rather than deliberative, systems for low-level waste policy-making. Concerns about distributional fairness arise because the benefits and risks of alterative low-level waste policies accrue to different stakeholders. Risk assessment is faulted for failure to acknowledge hidden subjective assumptions (e.g., on screening vigilance in materials recycling, on integrity of disposal facilities in the far future). Skepticism of technological risk management arises from a history peppered with unexpected untoward events that lay outside the design bases of protection systems. Finally, public interest groups view low-level waste issues as part of a larger debate on wise and legitimate energy policy, and are reluctant to support measures that provide relief to a nuclear industry that, in their view, established itself outside the democratic process.     

Public health policy-making in the presence of incomplete evidence.

In conclusion, when it can be demonstrated that the need is great, an action produces the desired benefits, the risks are not too high, the intervention is economically feasible, and there are no viable, more scientifically certain alternatives, then policy-makers should proceed even in the face of less than complete evidence. It should be remembered that scientific uncertainty may be exploited by special interest groups as a shield for opposition to the measure. Public policy decisions may be said to be made or not made on the basis of scientific uncertainty, but they may in actuality be driven by political or economic considerations. With respect to balancing individual rights and the public interest, it is clear that, in many instances, these two interests will be congruent. If they conflict, however, then weight should be given to the public interest in line with the principle that public health is social justice.     

Still moving toward environmental justice.

Three years in the making, the Institute of Medicine report Toward Environmental Justice was funded by a consortium of agencies, including the NIEHS, the Centers for Disease Control and Prevention, the U.S. Environmental Protection Agency, and the U.S. Department of Energy. The independent review was authored by a 15-member committee that represented academia, public interest, medicine, law, and industry. The committee met with stakeholders, citizens, public officials, and industry representatives around the United States to assess the need for better research, education, and health policy related to environmental justice. The report investigates the situation of groups of individuals suspected of having disproportionately high levels of exposure to environmental stressors such as chemicals, biologics, allergenics, toxicants, light, noise, odors, and particulate matter. The report calls for more research to help identify and verify the environmental etiologies of diseases. It also recommends that citizens be recruited to participate in the design and execution of the research, and that communication during all phases of the research be open and reciprocal.     

Combined effects of uncertainty and organizational justice on employee health: testing the uncertainty management model of fairness judgments among Finnish public sector employees

We examined whether the combination of uncertainty (lack of work-time control, and negative changes at work) and organizational justice (i.e., justice of decision-making procedures and interpersonal treatment at work) contributes to sickness absence. A total of 7083 male and 24,317 female Finnish public sector employees completed questionnaires designed to assess organizational justice, workload and other factors. Hierarchical regression showed that after adjustment for age, income, and health behaviors low procedural and interactional justice were related to long sickness absence spells. In accordance with the uncertainty management model, these associations were dependent on experienced work-time control and perceived changes at work.     

Procedural justice in public healthcare resource allocation

Introduction

The legal studies literature on procedural justice identifies six key characteristics of procedural justice: accuracy, consistency, impartiality, reversibility, transparency and voice. However, the relative importance of these in the context of public healthcare resource allocation is unclear, as is whether they are valuable instrumentally (because it contributes to better outcomes) or inherently (for its own sake).

Methods

A survey of 80-odd members of the UK public determined the following: the ranking of all the six characteristics; the pairwise comparisons of the characteristics; and whether each characteristic was important for instrumental reasons, for intrinsic reasons or for both.

Results

Respondents ranked the procedures in the order of accuracy, consistency, impartiality, reversibility and transparency. Procedural justice was valued for both instrumental and inherent reasons.

Discussion/conclusion

A robust ranking of five of the six procedural characteristics was found. The ranking for voice was sensitive to the question format, which has methodological implications. Around a quarter to a third of respondents regarded a procedural characteristic to have entirely intrinsic value.     

Vaccines--but not as we know them: an ethical evaluation of HPV vaccination policy in Australia

Objective: To show how systematic ethical evaluation of public health policy may reveal issues of moral significance for critical examination. Method: Using Australia's human papillomavirus (HPV) vaccination program as an exemplar and adopting an approach outlined elsewhere, we determine whether conditions of effectiveness, proportionality, necessity and least infringement, and public justification, are met such that any breach of autonomy or justice principles associated with this intervention can be defended. Conclusions: While the HPV vaccine itself may be efficacious, some aspects of the program lack sufficient moral justification and raise concerns around procedural and social justice and gender equity. Implications: Public health interventions deploying new technologies against new targets – such as vaccines against cancer and chronic illness – require approaches crafted to their specific risk‐benefit profiles that have carefully considered the ethical issues involved. Systematic ethical reflection is a useful tool for this.     

Myths as barriers to health care reform in the United States.

The U.S. health care system is deteriorating in terms of decreasing access, increased costs, unacceptable quality, and poor system performance compared with health care systems in many other industrialized Western countries. Reform efforts to establish universal insurance coverage have been defeated on five occasions over the last century, largely through successful opposition by pro-market stakeholders in the status quo. Reform attempts have repeatedly been thwarted by myths perpetuated by stakeholders without regard for the public interest. Six myths are identified here and defused by evidence: (1) "Everyone gets care anyhow;" (2) "We don't ration care in the United States"; (3) "The free market can resolve our problems in health care"; (4) "The U.S. health care system is basically healthy, so incremental change will address its problems;" (5) "The United States has the best health care system in the world"; and (6) "National health insurance is so unfeasible for political reasons that it should not be given serious consideration as a policy alternative." Incremental changes of the existing health care system have failed to resolve its underlying problems. Pressure is building again for system reform, which may become more feasible if a national debate can be focused on the public interest without distortion by myths and disinformation fueled by defending stakeholders.