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1.
通过对公共卫生体制改革演进过程的分析,认为改革之初的动因始自“政府失灵”现象的普遍,但以放权来激发卫生机构运行活力的改革,未能有效解决效率不高、质量低下、资源配置不合理问题,还导致卫生服务不公平性的日趋严重;而市场化取向的改革探索又遭遇诸多经济伦理问题。社会转型时期的公共卫生体制改革,必须以解决两个失灵和追求社会公平为主要目标,采取卫生资源增量改革为主、存量改革逐步跟进的方式,并对公共卫生服务的供给机制作出新的制度安排,以期整体提高卫生服务的绩效。  相似文献   

2.
试论医疗服务市场失灵、信息披露及其管制   总被引:4,自引:0,他引:4  
在现代经济学的框架中,公共产品、外部性、自然垄断和信息不对称的存在会导致市场失灵。我国医疗服务市场因其特殊的技术与经济特点也存在一般意义上的市场失灵,从而使市场机制对卫生资源的配置偏离了最优状态,也使政府管制这一非市场治理机制的产生与存在成为必要,以弥补与矫正市场失灵,保证医疗服务信息的充分、及时、完整披露,医疗服务市场的规范运行。  相似文献   

3.
回顾与总结了10个贫困县实施合作医疗3年来的经验和问题。贫困县的社会,经济状况决定需要国家财政转移支付,没有集体经济扶持,个人投入有限,年人均纯收入700元以上才有支付能力,意愿支付只有13元,供方分析农村卫生服务机构效率低下,完善合作医疗后医师处方行为发生改变,并对政府失灵及市场失灵的种表现进行了分析,最后提出了对贫困地区实施合作医疗的具体政策建议。  相似文献   

4.
“双失灵”导致药价虚高,即计划失灵导致政府定价虚高,市场失灵导致市场定价虚高.围绕着药品几乎所有环节都在牟利,但是,所有的牟利最终都是通过医者之手(特指医院药品经营)实现的.因此,要解决药价虚高,除了依靠体制变革外,更重要的是从规范医者用药行为入手.  相似文献   

5.
探讨医疗服务体制改革,我们既需要考虑如何利用市场的独特优势,也需要利用政府解决市场失灵问题,同时还要应对政府在解决市场失灵问题时自身可能发生的失灵。与医疗服务直接有关的社会力量,一是患者和潜在患者,一是医生、护士等医疗服务的提供者,以及传统的大众传媒、新兴的网络等。这些社会力量如果能够以适当的方式组织起来,成为医疗服务领域中的新角色,在各种关系之间形成必要的制衡,可在一定程度上避免医疗服务领域的两种“失灵”。  相似文献   

6.
新医改难以破解"看病难、看病贵"的深层原因在于,医药卫生政策在部门利益冲突、政策信息不对称、多元利益博弈、政策短视效应等因素的交互作用下出现失灵,而且医药卫生政策失灵进一步诱发政策客体的逆向选择行为,导致医药卫生政策越位与缺位并存,阻碍市场机制获得合理的空间和正确的定位。  相似文献   

7.
随着医疗卫生体制改革的逐步深化,防止“市场失灵”或过度市场化之类的提法在业界内外使用的频率也越来越高。卫生领域目前许多原因极复杂的问题,都在被越来越多的人简单地归结到“市场失灵”和过度市场化上。  相似文献   

8.
计划,市场失灵与国际卫生发展   总被引:1,自引:1,他引:0  
国家组织卫生事业的目的是利用有限的卫生资源公平、有效率地提供卫生服务,提高居民的健康水平。为了达到这样的目的,有两个可以为之利用的宏观措施,一是集权式的中央计划,二是市场调节。在世界各国卫生改革的过程中,有的是引入市场机制,有的则是更多的施加政府的干预和计划。两种调节各有弊端,这是本文拟回答的主要问题。 一、计划失灵与市场失灵 (一)计划失灵 为了实现卫生服务的公平分配,许多人主张采取计划型  相似文献   

9.
在市场经济条件下,政府规制的出现是因为存在市场失灵.公立医院的政府规制是政府治理医疗服务市场的一种工具.但无论是经济性规制还是社会性规制,无论是在规制制定还是规制执行中,都出现了某些政府规制失灵.因此,公立医院改革的关键在于建立健全法律法规体系,设置独立政府规制机构,扶植形成多元利益集团,适度放松经济性规制,加强社会性规制.  相似文献   

10.
市场机制和政府调节在卫生服务领域的功能与角色定位   总被引:7,自引:0,他引:7  
根据经济学理论,对现代社会存在的市场失灵和政府失灵现象及其在卫生服务领域的表现进行了分析,认为单纯利用市场机制无法使卫生行业健康发展,需要政府适度管制。在社会主义市场经济条件下,政府的主要责任是保障居民基本医疗服务,促进健康公平。  相似文献   

11.
从公共经济学的视角,对我国医疗卫生体制改革失败的事实进行分析,得出我国医疗体制改革失败的根本原因在于市场与政府的双失灵.认为破解医改的难题,关键在于纠正市场与政府的双失灵.  相似文献   

12.
Despite remarkable success of immunization programmes on a global perspective, vaccines are neither 100% efficacious nor 100% effective. Therefore, vaccination failure, i.e. occurrence of a specific disease in an individual despite previous vaccination, may occur. Vaccination failure may be due to actual vaccine failure or failure to vaccinate appropriately. Universally accepted concepts and definitions of vaccination failure are required to assess and compare the benefit of vaccines used in populations. Here we propose general definitions for types of vaccination failure. In the future, these should be complemented by specific definitions for specific vaccines as needed depending on public health considerations.  相似文献   

13.
本文阐述了妊娠合并心脏病引起心衰是产科领域和妇幼保健工作的重要课题,加强对患心脏病的孕产妇的孕前、孕期、分娩期及产褥期的保健和治疗,避免其心力衰竭的发生,降低孕产妇的死亡率,是医疗保健的重要内容之一。在妊娠合并心脏病中,以风湿性心脏病占绝大多数。心脏代偿功能在Ⅲ级及以上的孕产妇,心衰的发生率明显增高。本文就5例妊娠合并心脏病的结局,对保健及防治原则进行探讨。  相似文献   

14.
Has recognition of failure to thrive changed?   总被引:1,自引:0,他引:1  
Summary Studies of failure to thrive often work to different definitions, and replication studies are rarely undertaken. A recent study completed in southern England encompassed an area previously studied some 5 years earlier. Although recognition of failure to thrive was not the focus of this work, the data are used to draw some conclusions regarding changes in recognition. There has been an improvement in recognition of children whose weight falls below the 3rd centile. Previously one in three of these children passed unrecognized as such by health professionals. Recent work indicates that now only one in five children below the 3rd centile are not recognized by health professionals as a cause for concern. However, in extending a definition of failure to thrive to include children whose growth deviated from an established growth curve for 3 consecutive months, crossing major centile lines, it was found that one in two of these children were not picked up by health professionals. The case is made for improved recognition of failure to thrive, and the implications of current patterns of child health surveillance, including moves to parent-held records are addressed.  相似文献   

15.
Increasing numbers of people living with HIV (PLHIV) in sub-Saharan Africa are experiencing failure of first-line antiretroviral therapy and transitioning onto second-line regimens. However, there is a dearth of research on their treatment experiences. We conducted in-depth interviews with 43 PLHIV on second- or third-line antiretroviral therapy and 15 HIV health workers in Kenya, Malawi and Mozambique to explore patients’ and health workers’ perspectives on these transitions. Interviews were audio-recorded, transcribed and translated into English. Data were coded inductively and analysed thematically. In all settings, experiences of treatment failure and associated episodes of ill-health disrupted daily social and economic activities, and recalled earlier fears of dying from HIV. Transitioning onto more effective regimens often represented a second (or third) chance to (re-)engage with HIV care, with patients prioritising their health over other aspects of their lives. However, many patients struggled to maintain these transformations, particularly when faced with persistent social challenges to pill-taking, alongside the burden of more complex regimens and an inability to mobilise sufficient resources to accommodate change. Efforts to identify treatment failure and support regimen change must account for these patients’ unique illness and treatment histories, and interventions should incorporate tailored counselling and social and economic support.  相似文献   

16.
Background While generic health status measures quantify the impact of all patients’ diseases on their health-related quality of life, disease specific measures focus on only one of the many conditions that a patient may have. If a patient has two diseases with similar clinical manifestations, they may respond differently to a disease-specific instrument if one of their conditions improves while the other worsens or remains stable, thus undermining the instruments in that patient population. We sought empirical evidence of the reliability and validity (including responsiveness) of the Kansas City Cardiomyopathy Questionnaire (KCCQ), a disease-specific measure for heart failure (HF), among HF patients with and without anemia, a condition that has similar symptoms to HF. Methods This work used a prospective cohort study of 811 HF outpatients from 58 U.S. centers with a baseline assessment of anemia of whom 698 were followed for 3 months with serial health status measures. Results Among participants, 268 (33%) were anemic. The construct validity of the KCCQ was supported by showing similar correlations with the New York Heart Association (NYHA) classification in patients with and without anemia (P value for interaction = 0.38). The internal consistency (Cronbach’s alpha = 0.92 and 0.93 for anemic and non-anemic patients, respectively) and test–retest reliability (mean 3-month change scores in stable patients = −2.8 [SD = 1.4] and −0.5 [SD = 0.8], P = 0.14) were similar. Estimates of responsiveness were also similar. Conclusion This study provides empirical evidence that the psychometric properties of the KCCQ are similar in patients with or without anemia, a potentially confounding clinical condition in patients with heart failure.  相似文献   

17.
OBJECTIVE: To determine the impact of patient characteristics, clinical conditions, hospital unit characteristics, and health care interventions on hospital cost of patients with heart failure. DATA SOURCES/STUDY SETTING: Data for this study were part of a larger study that used electronic clinical data repositories from an 843-bed, academic medical center in the Midwest. STUDY DESIGN: This retrospective, exploratory study used existing administrative and clinical data from 1,435 hospitalizations of 1,075 patients 60 years of age or older. A cost model was tested using generalized estimating equations (GEE) analysis. DATA COLLECTION/EXTRACTION METHODS: Electronic databases used in this study were the medical record abstract, the financial data repository, the pharmacy repository; and the Nursing Information System repository. Data repositories were merged at the patient level into a relational database and housed on an SQL server. PRINCIPAL FINDINGS: The model accounted for 88 percent of the variability in hospital costs for heart failure patients 60 years of age and older. The majority of variables that were associated with hospital cost were provider interventions. Each medical procedure increased cost by $623, each unique medication increased cost by $179, and the addition of each nursing intervention increased cost by $289. One medication and several nursing interventions were associated with lower cost. Nurse staffing below the average and residing on 2-4 units increased hospital cost. CONCLUSIONS: The model and data analysis techniques used here provide an innovative and useful methodology to describe and quantify significant health care processes and their impact on cost per hospitalization. The findings indicate the importance of conducting research using existing clinical data in health care.  相似文献   

18.
Home telemonitoring can augment home health care services during a patient's transition from hospital to home. Home health care agencies commonly use telemonitors for patients with heart failure although studies have shown mixed results in the use of telemonitors to reduce rehospitalizations. This randomized trial investigated if older patients with heart failure admitted to home health care following a hospitalization would have a reduction in rehospitalizations and improved health status if they received telemonitoring. Patients were followed up to 180 days post-discharge from home health care services. Results showed no difference in the time to rehospitalization or emergency visit between those who received telemonitoring versus usual care. Older heart failure patients who received telemonitoring had better health status by home health care discharge than those who received usual care. Therefore, for older adults with heart failure, telemonitoring may be an important adjunct to home health care services to improve health status.  相似文献   

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