公共卫生资源配置与社会信任--兼论分级诊疗的基础

目的:探明公共卫生资源配置对社会信任的影响,以期通过信任合作更好的实现分级诊疗。方法:根据《中国城市统计年鉴2013》宏观数据及CGSS微观调查数据,利用OLS及Odered probit模型进行实证研究。结果:发现公共卫生资源配置充足度以及均衡度在宏观层面均对社会信任水平产生正向影响,城乡卫生资源配置差异对农村居民产生显著正向影响,城乡卫生资源分配越均衡,农村居民社会信任水平越高,而对全样本和城市军民样本作用不显著,结论:分级诊疗制度的成功实施,既有赖于居民对基层医疗服务体系的信任,也有赖于国家对基层公共卫生服务体系的投资。     

系统动力学在我国卫生服务领域中的应用及动态演进分析

目的:探究系统动力学(System Dynamics, SD)在我国卫生领域中的应用现状、研究热点和未来研究方向。方法:以中国知网(CNKI)为文献数据来源,从文献计量学的角度,对发文量、关键词等方面进行分析,明确SD在国内卫生领域应用的研究热点,探索未来研究方向。结果:SD在卫生领域中的研究起步较好,有关SD在卫生服务领域中的应用文献数量呈波动式上升。医院补偿机制、慢性病防控、分级医疗和卫生费用预测等成为卫生领域的研究热点。结论:SD在卫生服务研究领域中的应用研究尚处于探索阶段。研究热点将不断拓展,新的研究主题将继续涌现,慢性病防控与管理、基层卫生服务和卫生资源配置公平与效率等问题将成为SD在卫生领域中的重要选题。     

基于政策工具的我国1999—2023年心理健康和精神卫生政策文本量化分析

目的 总结我国心理健康和精神卫生领域相关政策的关键要素及不足,以期为我国心理健康和精神卫生领域后续政策的制定与完善提供参考借鉴。方法 运用NVivo11 Plus软件,采用内容分析法,构建“政策工具-政策客体”二维分析框架,对我国1999—2023年共141份国家层面的心理健康和精神卫生领域相关政策文本进行量化分析。结果 国家对于心理健康和精神卫生重视程度越来越高;国家卫生健康委、教育部、民政部是政策制定的核心部门;供给型政策工具内部结构失衡,环境型政策工具应用不足,需求型政策工具使用最少,占比分别为49.96%、28.36%、21.68%;政策客体集中在整体、卫生系统和教育系统,占比分别为32.81%、24.59%、21.94%。结论 建议今后在政策设计上应平衡政策工具结构,增加资源供给、运用策略措施、加强心理健康教育和促进、强化社区基层精神卫生服务、规范社会心理健康服务机构发展,完善心理健康和精神卫生政策体系。     

发达国家社会工作在卫生领域参与现状分析

本文结合几个发达国家社会工作在卫生领域的实践经验,认定两个领域合作的协同作用突出体现在两个方面:从卫生需求角度出发,帮助公众获得及时有效的卫生服务,加强卫生服务供给的及时和有序性,增强服务的公平性,提高资源利用效率;从卫生供给角度出发,通过卫生服务流程的有效分解和相关技能培训,社会工作者承担卫生需求发现、健康促进、康复看护等环节职责,缓解卫生人员工作压力,提升服务质量与连续性,使卫生服务供给的完整性与连续性成为可能。     

谈谈卫生文化

一、什么是卫生文化１．卫生文化的涵义什么是卫生文化？从广义看，卫生文化是千百年来人类的卫生保健活动中所创造的物质文化和精神文化的总和。从狭义看，卫生文化是指卫生领域精神文化的总和。卫生文化与社会文化的其他部分一样，也存在着三个层面：第一个层面即外层（或表层），是卫生物态文化，即以物质形态存在的文化，也可称之为卫生物质文化。卫生物态文化是指存在于各种卫生设施、医疗器诫设备、药品和卫生材料、医学科学技术中的文化，其中最重要的是医学科学技术。医学科学技术与物相结合，就表现为物质文化；与人相结合，就表现…     

杭州市居民对社区卫生服务信任的影响因素研究

目的在对信任积累的长期性与阶段性特质分析的基础上,从居民对社区卫生服务的初始信任、持续信任、推荐信任三个阶段找出影响居民对社区卫生服务信任的因素,为更好地发展社区卫生服务提供依据。方法 2016年9—11月,在杭州市6个主城区选取10家社区卫生服务中心,采用定额抽样的方法,拦截就诊或者附近居住的18~70岁的居民进行问卷调查。一般描述性统计分析居民对社区卫生服务信任的基本情况,秩和检验法分析不同信任阶段影响居民对社区卫生服务机构信任的因素,P0.05为差异有统计学意义。结果初始信任阶段,社区卫生服务机构的声誉、居民获得信息的质量、医保制度的保障、双向转诊制的保障、居民个人的信任倾向对居民产生影响。持续信任阶段,社区卫生服务机构的环境、内部管理、信息公开化、候诊时间、诊疗能力对居民产生影响。推荐信任阶段,居民推荐他人就诊的方式、推荐路径、推荐个数对居民产生影响。结论初始信任阶段加强宣传,给居民提供高质量的信息,促使居民去社区卫生服务机构就诊。持续信任阶段要优化社区卫生服务机构的环境,减少排队等待的时间,提升诊疗能力,为居民提供舒适、高效的就诊体验。推荐信任阶段,鼓励居民推荐他人去社区卫生服务机构就诊,采取措施调动居民推荐的积极性。     

数字健康公平：理论视角与影响因素

数字时代推动卫生健康现代化和促进卫生健康领域共同富裕,不可回避健康公平的问题。数字健康公平包括基于创新扩散理论的利用公平,以及基于数字正义理论的算法公平。数字健康公平的影响因素包括4个层面：个体层面（包括数字健康信念、数字健康素养、数字健康信任）、人际层面（包括人际传播和群体偏见）、社会层面（包括基础设施、大众传播、法治监管）和系统层面（包括数据质量、算法标准、结果审查）。     

卫生服务公平性及其影响因素研究综述

公平性是社会文明程度的重要指标之一，保证社会成员得到公平有效的卫生服务是政府在卫生领域追求的重要目标之一。卫生服务的公平性研究逐渐引起卫生政策研究者和决策者的重视，并渐渐成为卫生改革领域的研究热点。本文试通过文献检索，综述我国目前在卫生服务公平性方面的研究进展，为进一步研究提供参考与借鉴。     

流动老年人卫生领域公共服务获取对社会融入的影响研究——基于2017年全国流动人口卫生计生动态监测调查数据

目的:探讨流动老年人的卫生领域公共服务获取情况,以及对社会融入的影响。方法:基于2017年全国流动人口卫生计生动态监测数据,以社会支持理论为支撑,建立多元线性回归模型,分析卫生领域公共服务的获取对流动老年人社会融入的影响。结果:卫生领域公共服务的获取显著影响流动老年人生活质量,进而影响社会融入。结论:加强卫生领域公共服务体系建设,实现卫生领域公共服务均等化发展,提高城市包容度。     

浅议卫生部门对涉嫌犯罪案件的移送

为打击卫生领域犯罪行为,卫生行政部门对日常执法检查中发现的涉嫌犯罪的违法行为应当及时移送.作者分析了不能及时移送的原因,提出了增强卫生行政法规和刑事法律衔接性、明确卫生执法证据材料在刑事诉讼中的法律地位、加强行政执法人员相关法律知识培训、建立、健全卫生执法与刑事司法相衔接的工作制度、加强执法监督等七个方面的建议,以期进一步规范卫生部门对涉嫌犯罪案件的移送.     

Social capital and self-rated health: results from the US 2006 social capital survey of one community

Using data from the 2006 Social Capital Community Survey in Duluth, Minnesota, and Superior, Wisconsin, USA, we investigate associations between individual social capital measures (attitudes on trust, formal group involvement, informal socializing, organized group interaction, social support and volunteer activity) and self-rated health after controlling for individual and economic characteristics. In particular, we address issues of social capital as an endogenous determinant of self-reported health using instrumental variables probit estimation. After accounting for the endogeneity of these various measures of individual social capital, we find that individual social capital is a significant predictor of self-rated health.     

Social capital and self‐rated health: A cross‐sectional study of the general social survey data comparing rural and urban adults in Ontario

The concept of social capital shows great promise for its potential to influence individual and population health. Yet challenges persist in defining and measuring social capital, and little is known about the mechanisms that link social capital and health. This paper reports on the quantitative phase of a sequential explanatory mixed methods study using data from Canada's 2013 General Social Survey (data collected 2013–14). An exploratory factor analysis revealed six underlying dimensions of social capital for 7,187 adults living in Ontario, Canada. These factors included trust in people, neighbourhood social capital, trust in institutions, sense of belonging, civic engagement, and social network size. A logistic regression indicated that having high Trust in People and Trust in Institutions were associated with better mental health while high Trust in Institutions, Sense of Belonging, and Civic Engagement were associated with better physical health. When comparing rural and urban residents, there were no differences in their self‐reported health, nor did social capital influence their health any differently, despite rural residents having higher social capital scores. The study findings are important for understanding the nature of social capital and how it influences health, and provide direction for targeted health promotion strategies.     

Social networking for medical information: A digital divide or a trust inquiry?

ObjectiveTo profile social networkers and those who use social networks for medical purposes and investigate the role of three behavioural triggers related to control, trust and privacy.Data sourcesWe use data from Europe (Eurobarometer 74.3, 2010) containing information about reported behaviour and perceptions on social issues such as media, privacy and social networking.Study designProbit models showing associations between individual socio-economic variables and reported social networking, and social networking for health. Extra variables proxying for control, trust in health care providers and privacy of personal information are then added. Following this, two part models accounting for zero observations are utilised.FindingsThe age profile of social networkers using it for medical care differs from that of social networkers per se. Privacy perceptions appear to be a deterrent of social networking whilst trust in the health care providers is not a significant driver of social network use.ConclusionsThere is some evidence of a digital divide owing to age, while income is not significantly associated with social networking for health. Social networking does not perfectly substitute for conventional health care.     

The political divide in health care: a liberal perspective

U.S. health policy has been consumed by an ideological divide between conservative and liberal viewpoints. The liberal philosophy, based on both moral principles and utilitarian arguments, attempts to balance the needs of the individual with the concerns of the entire population. Elements of the liberal health care perspective include a belief that health care is an equal right of all people, the implementation of that right through a social insurance system that provides universal health coverage, equitable financing of health care, and a commitment to equality in health care.     

卫生监督执法的道德保障

文章对卫生监督执法的道德保障问题进行探讨。分析职业道德建设在卫生监督执法中的重要性．及其社会背景因素：现行卫生监督体制上存在的问题；社会上腐败现象；全球化影响．并针对性地提出5项道德保障措施：构建职业道德教育新体系；提高卫生监督人员综合素质；改革现行卫生监督体制；强化领导、抓好制度建设、健全监督制约体系；营造有利于卫生监督职业道德建设的社会氛围．全面实施卫生监督信用建设。     

Do prevailing theories sufficiently explain perceptions and health‐seeking behavior of Ghanaians?

The challenges faced by African countries that have pioneered a national health insurance scheme (NHIS) and the lessons learned can be of great value to other countries, contemplating the introduction of such a health financing system. In 2003, Ghana initiated the NHIS to provide access to healthcare for people in both the formal and informal sectors. The paper assesses the applicability of four theoretical models to explain the perceptions and decisions of Ghanaians to participate in the NHIS. To contextualize these models, we used qualitative data from individual and group interviews of Ghanaians. These interviews form part of the study “towards a client‐oriented health insurance system in Ghana” to explain the uptake of the Ghanaian social health insurance. The paper argues for a new integrated model to provide a better understanding of clients' perceptions on illness, healthcare and health insurance. Such a model should highlight trust as a fundamental factor influencing the decision of Ghanaians to enroll in the NHIS. Copyright © 2013 John Wiley & Sons, Ltd.     

Moral Distress: Tensions as Springboards for Action

In the previous four papers in this series, individual versus structural or contextual factors have informed various understandings of moral distress. In this final paper, we summarize some of the key tensions raised in previous papers and use these tensions as springboards to identify directions for action among practitioners, educators, researchers, policymakers and others. In particular, we recognize the need to more explicitly politicize the concept of moral distress in order to understand how such distress arises from competing values within power dynamics across multiple interrelated contexts from interpersonal to international. We propose that the same socio-political values that tend to individualize and blame people for poor health without regard for social conditions in which health inequities proliferate, hold responsible, individualize and even blame health care providers for the problem of moral distress. Grounded in a critical theoretical perspective of context, definitions of moral distress are re-examined and refined. Finally, recommendations for action that emerge from a re-conceptualized understanding of moral distress are provided.     

Core values in health care reform: a communitarian approach

Controlling health care costs should allow the nation to provide more health services and higher quality care to more people. The authors are concerned, however, that many of the reform efforts will unwittingly undermine the culture of care in their pursuit of savings and access. This article is a plea to maintain the core moral values and the social and institutional commitments that are essential in the delivery of care, so that the health care community is not turned into a health industry. The authors' communitarian approach aims to preserve the balance between individual rights and social responsibilities, the moral integrity of a caring society, and the unique character of mutual trust between patients and health care personnel. They advocate an orientation toward preventing disease and promoting health, an imperative of reforming the violent, reckless, and costly aspects of American society, and a moral justification for cutting administrative waste, defensive medicine, and excessive profits rather than rationing beneficial and humane health services.     

广州市社会医疗保险制度的公平性研究

在社会调查和相关统计资料的基础上,从独立统筹区之间参保、医保制度之间待遇水平、参保人与全人群之间卫生服务利用、医患道德风险行为影响等4个方面,评价广州市社会医疗保险制度的公平性状况.针对公平性建设中的不足,提出几点合理化建议:继续扩大社会医疗保险的覆盖面,加快医保制度之间的统筹协调发展步伐,推行以预付制为主的医方补偿机制,确定合理的医疗费用患方分担机制.     

On justice and social institutions in the health care sector

The distribution of health care is dominated by nonmarket social institutions. In health economics, this allocation pattern is explained by referring to market failures of bearing risks. Howe er, as health is a moral related phenomenon, the nonmarket distribution of health care cannot be explained from an economical point of iew alone. In this paper, we present two of the most influential current moral theories, John Rawls’s egalitarian and Robert Nozick’s liberal theories of justice, and how they ha e been applied to health care. We find that both egalitarians as well as liberals argue for nonmarket social institutions in the health care sector. Ob iously, there is a parallelism between social institutions due to market failures and those due to moral conictions. Due to this parallelism, health economists implicitly refer to non-economic arguments when they explain the coming into being of social institutions in the health care sector.