从临床医生视角看香港医疗对内地的启示

香港与内地有不同的政治、经济基础和社会背景,其医疗制度的选择有着不同的道路。笔者从医疗政策、管理及服务方面简要介绍香港的医疗概况,从临床医生的角度,将香港医疗与内地医疗进行对比,思考差异存在的原因,得出内地医疗卫生体制改革值得借鉴的经验。     

论我国紧急医疗卫生救援立法——5.12地震的启示

紧急医疗卫生救援制度是在紧急状态下为公民提供医疗卫生服务的卫生法律制度。"5·12"地震的发生暴露出我国现行紧急医疗卫生救援制度还存在法治化程度低、费用保障不明确等问题。健全和完善紧急医疗卫生救援立法是我国应对大规模自然灾害、重大突发事件以及平时提供急救医疗服务的必然选择。     

基于集中指数对我国居民医疗服务利用公平性比较分析

正"十三五"卫生与健康规划对"十二五"期间我国医疗卫生服务情况进行了总结,指出了在"十二五"期间,由于医药卫生体制改革的不断推进,我国医疗卫生服务体系在不断地完善,医疗卫生的服务能力也大幅提升,并提出在"十三五"期间将会积极推进分级诊疗制度的完善,进一步改善医疗服务[1]。本文对2011年和2016年我国医疗卫生服务利用情况进行比较分析,探讨五年计划改变后我国医疗服务利用的公平性的变化情况,为提高我国居民医疗服务利用的公平性、优化医疗卫生     

购买服务:破解医疗服务难题

新医改在制度设计时考虑到"保障人民群众基本医疗"问题,提出了通过政府财政补助基层医疗服务机构,从而使其为民众提供"低费用医疗服务"的政策,但这项政策与我国实行的"社会医疗保险"购买医疗服务的制度设计不匹配,在执行过程中出现了一些不良效果。如基层医疗卫生服务机构在政府直接投资建设、收支两条线管理等方式引导下实现了"旱涝保     

完善区域纵向医联体建设的思考——基于制度理性选择框架

区域纵向医联体是我国医疗卫生体制改革的重要举措。该制度的出台源于我国医疗服务体系的"金字塔"型架构与医疗资源配置和患者就医的"倒金字塔"型现状的矛盾。但受旧有医疗卫生体制的惯性、配套政策滞后、患者认同度低等因素的影响,医联体建设仍面临着诸多瓶颈。基于制度理性选择框架的分析发现,医联体制度的行动舞台呈现与医联体的制度设计存在明显偏差。需要构建长效治理机制重构行动舞台,才能实现医联体制度的建设初衷。     

实现基本医疗卫生服务均等化的条件、问题和建议

城乡居民如何在城乡一体化和新医改的背景下实现基本医疗卫生服务均等化,是值得研究的一个问题。通过对"基本医疗卫生服务"、"一体化"和"均等化"等基本概念的辨析和对实现基本医疗卫生服务均等化必要性及有利条件的分析,总结了在认识、内容和路径等几个方面有待解决的问题,提出转变观念,提高认识;明确享有基本医疗服务均等化的对象;合理界定基本医疗服务均等化的内容;全面实施城乡居民统一的基本医疗保险制度;加强农村医疗卫生机构和人才队伍的建设;采取积极稳妥的推进步骤等建议。     

基层医疗卫生机构实行收支两条线管理有关问题的思考

为推进基本药物制度改革试点,我省部分地区开始探索基层医疗卫生机构实施收支两条线管理,但与医疗卫生机构的会计核算基础和医疗收费收入性质存在矛盾,同时,可能会使经济薄弱地区的财政难以承受,也给基层财政管理带来了压力。如何保障基层医疗卫生机构的建设与发展、运行质量和效率,作者提出调整医疗服务收入性质,满足非税收入管理需要;严格执行国家规定的财务会计制度,满足医疗服务管理需要;落实政府投入,满足基层医疗卫生机构的生存和发展需要;加大考核力度,提高基层医疗卫生机构的运行和服务质量;完善组织架构,有效开展收支两条线管理。     

台湾地区医疗服务体系管理的经验和启示

本文首先介绍了台湾地区卫生行政管理架构与医疗服务体系的基本情况,重点分析了台湾地区医疗服务体系管理的做法及特点,主要包括通过实行"医疗网计划",合理配置医疗卫生资源;发挥健保制度和医院评鉴的协同作用,规范医疗机构行为;通过"公办民营"提高公立医院效率,以公私平等政策鼓励社会力量办医;严格公立医院运行管理等。最后,提出了对我国加强医疗卫生服务体系规划管理的启示。     

凯撒医疗及其对我国紧密型县域医疗卫生共同体建设的启示

凯撒医疗是美国整合型医疗的代表,其独特的医疗卫生服务体系支撑着体系内部提供连续、一体化的服务,其经营理念、关键要素与我国紧密型县域医疗卫生共同体(以下简称"医共体")建设的内涵存在重叠效应。主要从服务体系、组织架构以及核心价值要素对凯撒医疗模式进行介绍。我国紧密型医共体建设应明确整合型县域医疗卫生服务体系的功能主体地位,以县域医疗保险为支点,建立"经济契约"关系,加强医疗信息联动。     

大陆已有22家台资及两岸合资医院

8月28日,在北京首家大陆和台湾合资医院——北京宝岛妇产医院试运营启动仪式上,卫生部港澳台办公室副主任王立基介绍说,截至去年年底,已有南京明基医院、厦门长庚医院等22家台资及两岸合资医院在大陆开设。王立基说。大陆目前正在进行医疗制度改革,完善医疗保险制度、医药卫生制度。随着社会需求不断增加,发展民营医院,鼓励和引导社会资本举办医疗机构,向社会提供多种形式的医疗卫生服务,是改革目标之一。“北京宝岛妇产医院为这种架构提供了活力,希望它能够充分引进台湾的医疗经验,为完善大陆的医疗卫生服务体系贡献力量,为北京民众提供良好的医疗卫生服务。”     

我国港澳地区医疗券制度及其对内地的启示

引入市场竞争机制是医疗体制改革的重点和难点。我国港澳地区的医疗券制度能够为内地推进医改体制创新、倒逼公立医院改革和合理配置医疗卫生资源提供借鉴。本文首先介绍了医疗券制度的起源和发展。然后详细阐述了港澳地区医疗券制度的实施背景、异同与政策效果,发现医疗券制度在引导需方更多使用私立医疗服务、提高居民预防保健意识、推广家庭医生制度等方面起到了积极作用。最后对医疗券制度在内地的适用性进行了分析,指出其与内地医改导向相契合,并可作为内地医保制度的有益补充和推动社会办医的有效措施,在完善内地医疗保险、医疗救助制度和发展私立医疗机构等方面具有一定的可行性。     

英国、新加坡和中国香港全民医保的运行及启示

作为医疗保障制度较为健全的国家和地区,英国、新加坡和中国香港三地的全民医疗保障体系经常成为学术界的研究对象。英国是全民免费医疗的典范,新加坡是政府主导的混合型医疗保障模式的代表,香港则凭借着质优价廉的公立医院服务享誉全球。本文将从卫生筹资的公平性、个人的可负担能力、医疗保障的覆盖模式、卫生筹资的可持续性以及个人责任的承担这五个核心维度来评估三地医疗保障系统的优越性和局限性,以期为我国新时期医疗改革的深化提供借鉴与参考。     

Organizing mental health services: an evidence-based approach

BACKGROUND AND AIMS: Health policy makers and program developers seek evidence-based guidance on how to organize and finance mental health services. The Swedish Council on Technology Assessment in Health Care (SBU) commissioned a conceptual framework for thinking about health care services as a medical technology. The following framework was developed, citing empirical research from mental health services research as the case example. FRAMEWORK: Historically, mental health services have focused on the organization and locus of care. Health care settings have been conceptualized as medical technologies, treatments in themselves. For example, the field speaks of an era of "asylum treatment" and "community care". Hospitals and community mental health centers are viewed as treatments with indications and "dosages", such as length of stay criteria. Assessment of mental health services often has focused on organizations and on administrative science. There are two principal perspectives for assessing the contribution of the organization of services on health. One perspective is derived from clinical services research, in which the focus is on the impact of organized treatments (and their most common settings) on health status of individuals. The other perspective is based in service systems research, in which the focus is on the impact of organizational strategies on intermediate service patterns, such as continuity of care or integration, as well as health status. METHODS: Examples of empirical investigations from clinical services research and service systems research are presented to demonstrate potential sources of evidence to support specific decisions for organizing mental health services. RESULTS: Evidence on organizing mental health services may be found in both types of services research. In clinical services research studies, service settings are viewed as treatments (e.g. "partial hospitalization"), some treatments are always embedded in a service matrix (e.g. assertive community treatment), and, where some treatments are organizationally combined (e.g. "integrated treatment" for co-occurring mental disorder and substance abuse), sometimes into a continuum of care. In service system research, integration of services and of the service system are the main focus of investigation. Studies focus on horizontal and vertical integration, primary care or specialty care and local mental health authorities - each of which may be conceptualized as a health care technology with a body of evidence assessing its effectiveness. IMPLICATIONS: A conceptual framework for assessing the organization of services as a health care technology focuses attention on evidence to guide program design and policy development. Mental health services research holds promise for such decision-making guidance.     

Economic development and the health care system in Hong Kong

This article describes parallel developments of the Hong Kong economy and its health care system. The purpose is to illustrate how the Hong Kong health system evolved in response to external and internal pressures generated by economic prosperity. The Hong Kong system illustrates the importance of clear policy making in the face of these pressures. In particular, issues of investment, financing and distribution of health services are examined in relation to hospital cost control and service accessibility. In the past, health care costs in Hong Kong have been controlled at the expense of limited accessibility of health services. At present, Hong Kong policy-makers are faced with the challenge of maintaining a sharp focus on cost control as they face pressure to expand and improve health care coverage for the citizens. So far they have responded by emphasizing management efficiency through reorganization. It remains to be seen whether this strategy can be successful without passing increased health care costs to the consumers.     

Quality and customers: Type 2 change in mental health delivery within health care reform

The traditional separation of mental health and medical programs is problematic because mental health issues are inseparable from the larger medical system. By contrast, a collaborative primary care model of mental health care, augmented and supported by secondary specialty mental health services, has the potential to optimize quality and cost goals while reinforcing health care reform principles. The flexibility of mental health treatment in this delivery structure provides opportunities to customize services according to patient and purchaser expectations. with the Hay Group Inc.     

To what extent can the publicly sponsored health system afford predictive genetic diagnostics?--first approaches to pinpoint and limit responsibilities,exemplified by hereditary carcinomas

Present predictive genetic tests for widespread multicausal and chronic conditions such as carcinoma and in the near future heart diseases and neurodegenerative conditions, urge their way into the health care system. In health care a change of the paradigm takes place: from caring for sick individuals to counselling and taking care of healthy persons and families burdened by a hereditary disposition. Essential for health care services is the question of actual advantage of the genetic tests for individuals, families as well as for society, and closely associated with the medical consequences of the tests. Decision makers in the financing of health care services are faced by the challenge to create a generally valid regulatory framework applicable for inclusion or refusal of present and future genetic tests by public health care services. Of relevance for those decisions are the questions whether the genetic tests make a difference in the impediment and primary prevention of disease, and the possibilities for successful early treatment.     

Rethinking prevention in primary care: applying the chronic care model to address health risk behaviors

This study examines the Chronic Care Model (CCM) as a framework for preventing health risk behaviors such as tobacco use, risky drinking, unhealthy dietary patterns, and physical inactivity. Data were obtained from primary care practices participating in a national health promotion initiative sponsored by the Robert Wood Johnson Foundation. Practices owned by a hospital health system and exhibiting a culture of quality improvement were more likely to offer recommended services such as health risk assessment, behavioral counseling, and referral to community-based programs. Practices that had a multispecialty physician staff and staff dieticians, decision support in the form of point-of-care reminders and clinical staff meetings, and clinical information systems such as electronic medical records were also more likely to offer recommended services. Adaptation of the CCM for preventive purposes may offer a useful framework for addressing important health risk behaviors.     

Problems of primary health care in a newly developed society: Reflections on the Hong Kong experience

Hong Kong has emerged as a newly developed society in Asia and its modern scientific health care system has had a substantial expansion. Recently, the rise of medical costs has made the health authority come to stress the development of PHC. This paper focusses on three major aspects of the PHC development in Hong Kong: (1) public health and preventive care; (2) food supply and nutrition; and (3) first-contact medical care and referral network.It is argued that in a newly developed society, the emphasis on developing both the quality and the quantity of PHC in the scientific biomedical stream is justifiable. However, at least two kinds of problems need to be taken into consideration, i.e. the prevalence of traditional beliefs and practices and the ever-rising demands of the public for health services.     

以社区为基础的医养结合策略分析

目的:对社区卫生服务机构参与医养结合服务的方式、所需资源及保障条件等可行策略进行归纳分析。方法:选取东、中、西部地区已开展医养结合服务且具有代表性的上海、武汉和重庆三地6家社区卫生服务机构进行现场调查和焦点组访谈,定性资料采取主题框架分析法。结果:社区卫生服务机构参与医养结合应以家庭医生签约服务为依托,借助信息化手段,以服务协作等方式不同程度参与;所需资源以人力资源、资金投入、设备和信息化建设为主;需要政策支持、多部门协作、支付制度、第三方参与等多重保障条件。结论:社区卫生服务机构是医养结合服务的重要平台,应充分依托家庭医生签约服务的开展,在不同形式下与养老资源进行协作融合;国家层面需做好顶层设计和相应标准,提高统筹层次。     

Improving the effectiveness of health care and public health: a multiscale complex systems analysis

The US health care system is struggling with a mismatch between the large, simple (low-information) financial flow and the complex (high-information) treatment of individual patients. Efforts to implement cost controls and industrial efficiency that are appropriate for repetitive tasks but not high-complexity tasks lead to poor quality of care. Multiscale complex systems analysis suggests that an important step toward relieving this structural problem is a separation of responsibility for 2 distinct types of tasks: medical care of individual patients and prevention/population health. These distinct tasks require qualitatively different organizational structures. The current use of care providers and organizations for both purposes leads to compromises in organizational process that adversely affect the ability of health care organizations to provide either individual or prevention/population services. Thus, the overall system can be dramatically improved by establishing 2 separate but linked systems with distinct organizational forms: (a) a high-efficiency system performing large-scale repetitive tasks such as screening tests, inoculations, and generic health care, and (b) a high-complexity system treating complex medical problems of individual patients.