四川省医疗卫生行业组织职能履行现状分析

目的 分析四川省医疗卫生领域行业组织的职能履行现状及存在的问题并提出建议。方法 通过问卷调查和定性访谈收集资料，用Excel对问卷结果进行统计描述；对访谈结果进行文字整理及定性分析。结果 受调查行业组织中目前履行最多的职能是组织行业培训、开展咨询服务和促进交流合作；在组织自律方面在实际发挥最好的是科普宣传与公益活动、维护行业公信力与信誉和加强行业人才培养培训。进一步分析，发现行业组织存在行业组织现有职能未充分履行；部分“硬”职能缺失，组织自律能力较弱；行业组织职能发挥缺少授权，法律与行政授权不足的问题。结论 以行业自律为切入点，明确自身职能；构建医疗卫生行业自律体系；试点探索下放职能，适度予以法律和行政授权。     

国外医疗卫生领域行业组织职能定位及启示

国外医疗卫生领域行业组织的主要职能包括：行业准入和再认证、行业自律、学术交流与促进、参政、服务行业及会员、维权等,权威的法律授权机制、综合的监管机制以及竞争性的市场化机制是其职能得以充分发挥的重要保障。     

国外医疗卫生领域行业组织功能定位及启示

国外医疗卫生领域行业组织的主要职能包括:行业准入和再认证、行业自律、学术交流与促进、参政、服务行业及会员、维权等,权威的法律授权机制、综合的监管机制以及竞争性的市场化机制是其职能得以充分发挥的重要保障。     

我国卫生治理中行业组织的角色定位与职能分析

行业组织是具有互益性的社会组织,医疗卫生行业的特殊性决定了行业组织应在卫生治理中发挥重要作用。目前,我国行业组织的角色定位和职能分工不明确,影响了卫生治理的发展水平。本文从理论上梳理行业组织的特点、职能,分析我国卫生治理的特点,提出医疗卫生行业组织在我国卫生治理中的角色定位和职能分工。在此基础上,提出了促使行业组织更好地发挥作用的政策建议。     

医疗卫生机构应急能力提升研究

目的探讨医疗卫生机构能力建设,提升县、乡二级医疗卫生机构应急处置能力。方法在对县、乡二级医疗卫生机构卫生应急能力进行调查的基础上,归纳总结应急能力建设中存在的突出问题,并提出探索性建议。结果县、乡二级医疗卫生机构应急能力建设中存在的主要问题为投入不足、卫生人才匮乏和卫生应急保障制度不健全。结论必须通过创新机制、增加专项投入、建立统一和规范的卫生应急职能机构等一系列的保障措施,着力提升卫生应急综合能力。     

我国医疗卫生领域引入PPP模式的问题与对策分析

从法律制度、运作体系、人才建设入手梳理了我国医疗卫生领域引入PPP模式存在的主要问题,并提出了建议,包括:提高对PPP模式的理性认识;加强政府引导,完善相关法律、法规及政策;加强医院PPP项目人才队伍建设。以期为促进我国医疗卫生PPP项目建设提供借鉴。     

实行行业管理是卫生事业发展的必然趋势

长期以来,卫生行政管理部门实行卫生全行业管理的职能很弱,主要功能是管理医疗卫生机构,不同的医疗卫生机构隶属于不同的系统作为独立的利益主体,有过多强调各自部门利益的倾向,缺乏必要的区域整体优化的意识,存在职能交叉、各自为政、自成体系,难以形成区域内卫生资源配置的合力优势。实施区域卫生规划,客观上要求改革卫生管理体制。卫生行政管理部门必须转变职能,从医疗机构直接管理者的身份中超脱出来,从自身的部门利益中超脱出来,以宏观调控者的身份,解决好卫生     

县乡级医疗卫生机构卫生应急能力建设思考

目的探讨提升医疗卫生机构卫生应急能力建设的措施。方法对县乡二级医疗卫生机构卫生应急能力调查的基础上,归纳总结了县乡医疗卫生机构卫生应急能力建设存在的问题,并提出相应的探索性建议。结果县乡二级医疗卫生机构卫生应急能力建设中存在的主要问题为投入不足、卫生人才匮乏、卫生应急管理体制和保障制度不健全。结论必须通过"创新机制、转变职能、增加专项投入、建立专门的卫生应急机构和服务设施"等一系列的保障措施,着力加强县乡级卫生机构卫生应急能力建设,增强卫生应急人员综合素质与技术理论水平,从根本上改变或提升县乡二级医疗卫生机构的卫生应急能力。     

我国公立医院管理与考核的现状、问题及政策建议

在国家增加医疗卫生投入、医疗保障覆盖面逐步扩大的情况下,加强对公立医院的考核监督,就成为保障医改效果最终实现的关键措施。目前,我国在医改中对公立医院的定位和作用认识还不够清楚、法律和政策框架不健全,尤其是对非营利性机构监管措施严重缺失;公立医院管理体制不完善,行业管理力度薄弱;公立医院治理结构不明晰,政府和公立医院之间的委托代理授权关系虚化;对公立医院考核监督体系不健全,考核结果没有充分起到激励公立医院改进绩效的作用。我们提出了强化对公立医院的监督管理的政策建议,一是明确公立医院定位,完善公立医院法制;二是理顺公立医院管理体制,提高管理能力;三是建立公立医院产权和财务管理制度;四是建立公立医院绩效考核和信息公开制度;五是加强对公立医院的立法监督和群众监督,建立公立医院审计制度和巡视制度;六是建立和完善公立医院数据收集和发布机制。     

我国纵向型区域医疗联合体的进展与挑战

纵向型区域医疗联合体是纵向整合型卫生服务体系的组织形式,对于实现区域医疗卫生服务整体效能最大化,使有限的卫生投入发挥最大效益,具有重要意义。本文综述了国内在纵向型区域医疗联合体方面的实践和进展,目前绝大部分的模式主要是通过医疗机构自身联合或行政手段支撑,外部政策支持不足,进展阻力较大。发现主要存在外部行政区划分割造成的体制性环境限制,外部运行机制性配套政策支撑不具协同性,各层级医疗机构纵向协作内在动力不足等问题,群众对于创新服务体系的组织形式缺乏理解和认同,区域卫生信息网络化滞后等。建议政府作为主要推动者,开展医联体顶层政策设计;在顶层政策设计下完善外部运行机制的各项配套政策;完善医联体运行的内部治理和外部评价机制;提高基层服务能力,提高患者对基层医疗卫生机构的认同感和信任度;对县域纵向整合型服务体系作出统筹的制度安排。     

我国行政诉讼受案现况与发展研究

目的　研究我国行政诉讼现状 ,为进一步完善行政诉讼提供依据。方法　对浙江、云南、福建 3省 ,保定、台州、合肥 3市相关案件进行分析。结果　公民的诉讼意识、行政机关的法治意识都有了很大程度的提高 ,人民法院审理行政案件的经验在逐渐积累 ,人民法院对行政案件的承受力在逐步加大或增强。行政诉讼受案范围等需进一步发展。结论　建立和完善行政法律救济体制 ,保证行政相对人的人权和在行政管理关系中的合法权益受到行政主体侵犯后 ,能获得及时、有效的救济 ,充分保护公民、法人或其他组织的合法权益 ,全面监督行政机关依法行使职权己势在必行     

Public control and equity of access to hospitals under non-State public administration

OBJECTIVE: To analyze social health organizations in the light of public control and the guarantee of equity of access to health services. METHODS: Utilizing the case study technique, two social health organizations in the metropolitan region of S?o Paulo were selected. The analytical categories were equity of access and public control, and these were based on interviews with key informants and technical-administrative reports. RESULTS: It was observed that the overall funding and administrative control of the social health organizations are functions of the state administrator. The presence of a local administrator is important for ensuring equity of access. Public control is expressed through supervisory actions, by means of accounting and financial procedures. CONCLUSIONS: Equity of access and public control are not taken into consideration in the administration of these organizations. The central question lies in the capacity of the public authorities to have a presence in implementing this model at the local level, thereby ensuring equity of access and taking public control into consideration.     

Medical education and the physician workforce of Iraq

The lack of resources in a country experiencing decades of successive wars, blockade, administrative corruption, and poor governance led to deteriorated standards throughout medical education. Although professional certification programs exist, continuing medical education accreditation and credit systems are required to monitor and certify the continuing professional development of physicians.     

对转型时期我国药品监管体制的宏观思考

法律制度的良好实施以科学的理念和有效的运行体制作为基础。当前,我国药品监管正处于转型时期,亟待建立起以风险规制理念为指导的现代监管体制。首先,需要在横向和纵向两个方面合理配置药品监管机构的职能,避免职能交叠和监管盲区,同时在事前与事中两个维度强化监管;其次,要进一步提升药品监管效能,对内提升监管部门自身能力,对外加强企业自控与行业自律;最后,要通过行政问责制督促药品监管部门依法履行职责,确保公众健康。     

卫生领域中政府管制作用的探讨

目的:探讨卫生领域中政府的管制作用。方法:通过文献复习进行理论探讨。结果:当前,我国卫生系统正面临着严重的信任危机。问题的根源是制度的缺陷,政府治理和监管的不足是关键。卫生系统改革中存在的诸多问题需要通过发挥政府的主导作用和充分利用市场的竞争机制来解决。医生的职业道德、伦理观、诚信及对患者的尊重和反应性在医患关系中处于主导的地位。对政府管制的认识应该是“管办分离,政事分开,分类管理”。政府部门将从“办卫生”转变为综合运用经济、法律和行政等手段来“管卫生”。卫生政策的制定要“以人为本”,要有及时性。结论:我国卫生改革成功的标志应该是:(1)要达到卫生服务的可及性和可承受性。解决和缓解“看病难、看病贵”问题;(2)要有公正的卫生筹资机制,建立全民的医疗保障制度是今后努力的方向;(3)具有良好的健康状况(4)要有一个创新的卫生体制和机制。     

Equity, governance and financing after health care reform: lessons from Mexico

To determine, from the perspective of providers, community leaders and users of health services, equity, governance and health financing outcomes of the Mexican health system reform.Cross-sectional study oriented towards the qualitative analysis of financing, governance and equity indicators for the uninsured population. Taking into account feasibility, as well as political and technical criteria, six Mexican states were selected as study populations and a qualitative research was conducted during 2004-2006. Two hundred and forty in-depth interviews were applied, in all selected states, to 60 decision-makers, including medical and administrative personnel; 60 service providers at health centres; 60 representatives of civil organizations, including municipal representatives and, finally, 60 members of health committees and users of services at second and first levels of care units. The analysis of interviews was performed using ATLAS-Ti software. An outcome mapping of health reform was developed. For political actors, Mexican health system reform has not modified dependence on the central level; ignorance about reform strategies and lack of participation in the search for financial resources to finance health systems were evidenced. Also, in all states under study, community leaders and users of services reported the need to improve an effective accountability system at both municipal and state levels. Health strategies for equity, governance and financing do not have adequate mechanisms to promote participation from all social actors. Improving this situation is a very important goal in the Mexican health democratization process, in the context of health care reform. There are relevant positive and negative effects of the reform on equity, governance and financing in health. Special emphasis is placed on the analysis of lessons learned in Mexico and the usefulness of the main strengths and weaknesses, as relevant evidences for other middle-income countries which are designing, implementing and evaluating reform strategies in order to achieve equity in resource allocation, good levels of governance and a greater financial protection in health.     

Improving health services in India: a different perspective

Two papers in this volume focus on public finance and decentralization as central to resolving India's systemic public health crisis. However, some states and districts have achieved success despite serious financial and administrative deficits; this suggests that factors such as political commitment, community participation, human resource management, women's empowerment, and governance may be as or more important. The success of the National Rural Health Mission will depend on state and local institutional capacity, including strong partnerships with civil society organizations and private-sector actors. Increased resources and decentralization will not be sufficient by themselves.