公立医院公益性建设的途径与对策

党的十七大报告中提出的坚持医疗卫生公益性,为医院体制改革指明了方向。以科学发展观为指导,解读了公益性的内涵,并从创新服务模式、加强医德医风建设和构建区域性健康维持网络3个方面阐述了加强公立医院公益性建设的途径与对策。     

我国公立医院社会公益性缺失的根源及对策

一段时期以来,部分公立医院逐步由提供基本医疗服务、预防为主、追求社会公益等非营利性行为向提供特殊医疗服务、治疗为主、追求经济利益等营利性行为转变。这一转变带来的最大危害可能是造成我国医疗费用的过快上涨。因此,如何保证公益性就成为公立医院改革的突破口。     

四川省公立医院公益性相关支出与财政投入现状分析

目的:了解四川省县级及县级以上公立医院2003～2007年的公益性相关支出与财政投入现状,为完善公立医院补偿机制提供参考依据。方法:采用文献复习、专家咨询、问卷调查等方法了解公立医院公益性相关支出与财政投入现状,采用SPSS15.0软件对数据进行分析。结果:四川省三级财政对县及县以上公立医院投入不足;医院筹资渠道单一;公益性相关支出逐年增加,财政没有对其专项列支,且补助金额不足。结论:四川省各级财政应加大对公立医院的投入,保障公共服务经费,落实病人欠费买单者;公立医院应拓宽筹资渠道、增收节支,减轻政府负担;取消药品加成,扭转趋利行为,真正回归公益性。     

个人疾病痛苦与公共政策议题:重塑公共卫生政策角色

个人疾病是个人麻烦还是公共政策议题,是医疗服务和卫生政策设计时必须回答的基本问题.个人疾病痛苦转变为公共卫生政策议题是世界历史和文明社会发展的基本规律,实质是国家职能角色的社会定位,理论基础是结构主义社会观取代个人主义社会观,使卫生政策涵义深远.     

公立医院区域化公益活动的探索与实践

介绍了某医院通过区域化合作,组成"惠民医盟"社团组织,着眼共同需求、共同目标,积极探索区域化、专业化、社会化、项目化的医疗服务机制,形成了互惠共赢的局面。     

Policy process for health sector reforms: a case study of Punjab Province (Pakistan)

The health sector in the Punjab (Pakistan) faces many problems, and, the government introduced reforms during 1993–2000. This paper explores the policy process for the reforms. A case study method was used and, to assist this, a conceptual framework was developed. Analysis of four initiatives indicated that there were deviations from the government guidelines and that the policy processes used were weak. The progress of different reforms was affected by a variety of factors: the immaturity of the political process and civil society, which together with innate conservatism and resistance to change on the part of the bureaucracy resulted in weak strategic sectoral leadership and a lack of clear purpose underpinning the reforms. It also resulted in weaknesses in preparation of the detail of reforms leading to poor implementation. The study suggests a need for broadening the stakeholders' base, building the capacity of policy‐makers in policy analysis and strengthening the institutional basis of policymaking bodies. Copyright © 2009 John Wiley & Sons, Ltd.     

Regulating private health insurance to serve the public interest: policy issues for developing countries

Private health insurance plays a large and increasing role around the world. This paper reviews international experiences and shows that private health insurance is significant in countries with widely different income levels and health system structures. It contrasts trends in private health insurance expansion across regions and highlights countries with particularly important experiences of private coverage. It then discusses the regulatory approaches and policies that can structure private health insurance markets in ways that mobilize resources for health care, promote financial risk protection, protect consumers and reduce inequities. The paper argues that policy makers need to confront the role that private health insurance will play in their health systems and regulate the sector appropriately so that it serves public goals of universal coverage and equity.     

Implementation of public policy on alcohol and other drugs in Brazilian municipalities: comparative studies

One of the challenges with respect to public health and the abuse of alcohol and other drugs is to implement policies in support of greater co‐ordination among various levels of government. In Brazil, policies are formulated by the Secretaria Nacional de Políticas sobre Drogas (SENAD – State Department for Policies on Drugs) and the Ministério da Saúde (MS – Ministry of Health). This study aims to compare implementation of policies adopted by SENAD and MS at the municipal level. Three municipalities were intentionally selected: Juiz de Fora having a larger network of treatment services for alcohol and drug users; Lima Duarte, a small municipality, which promotes the political participation of local actors (COMAD – Municipal Council on Alcohol and Drugs); and São João Nepomuceno, also a small municipality, chosen because it has neither public services specialised to assist alcohol and other drugs users, nor COMAD. Data collection was conducted through interviews with key informants (n = 19) and a review of key documents concerned with municipal policies. Data analysis was performed using content analysis. In Juiz de Fora, there are obstacles regarding the integration of the service network for alcohol and other drug users and also the articulation of local actors, who are predominant in the mental health sector. In Lima Duarte, while there is a link between local actors through COMAD, their actions within the local service network have not been effective. In São João Nepomuceno, there were no public actions in the area of alcohol and drugs, and consequently insufficient local debate. However, some voluntary, non‐governmental work has been undertaken. There were weaknesses in the implementation of national‐level policies by SENAD and the MS, due to the limited supply of available treatment, assistance and the lack of integration among local actors.     

试论公立医院产权改革过程中公益性的实现——以江苏省宿迁市为例

以江苏省宿迁市公立医院产权改革为案例,探讨了公立医院产权制度改革过程中公益性的实现途径。