基于利益相关者理论的新型农村合作医疗评价指标体系构建

利益相关者分析作为一种新的理论，已经广泛应用于卫生管理与卫生政策研究，并取得了初步成效。文章以利益相关者理论为基础，系统地分析了新型农村合作医疗制度的主要利益相关者和次要利益相关者的需求、贡献和目标。在利益相关者分析的基础上，构建了简明实用的新型农村合作医疗评价指标体系，包含了3个一级指标，12个二级指标以及24个三级指标。     

我国结核病防治纳入新型农村合作医疗现状研究

目的:文章旨在通过分析我国结核病防治纳入新型农村合作医疗现状,为改进结核病防治工作、改善农民卫生服务状况和完善新型农村合作医疗政策提供依据。方法:采取全国横断面问卷普查方法,结合利益相关者深度访谈,对全国结核病防治机构实施结核病纳入新型农村合作医疗情况进行调查。结果:该政策实施在一定程度上使结核病患者卫生服务利用增加、经济负担减轻、医疗卫生服务和管理水平均有所提高。结论:新型农村合作医疗对结核病的补偿政策可推动结核病防治工作,对该政策进一步完善可在更大范围内科学推广。     

乡村卫生服务机构门诊用药与新型农村合作医疗

通过对新型农村合作医疗试点地区乡村卫生服务机构门诊处方费用、药品使用种类、激素和抗生素使用频率、给药方式等及农民对新型农村合作医疗的参与意愿和新型农村合作医疗主体行为的分析，结果显示：乡、村两级卫生服务机构门诊用药均存在严重的不合理性，这将成为影响新型农村合作医疗发展的重要障碍。提出在新型农村合作医疗的运行中，一方面需加强对医务人员合理用药的培训；另一方面需通过调整支付方式、制定并执行基本药物目录和诊疗规范等措施，促进乡村卫生服务机构合理提供药品服务，促进新型农村合作医疗的稳步发展     

社区卫生服务机构实行收支两条线管理的利益相关者分析

利用利益相关者理论分析社区卫生服务机构实行收支两条线管理的各方利益者.其中主要利益相关者是社区居民、社区卫生服务机构及其医务人员,次要利益相关者是地方政府和卫生主管部门,外部利益相关者是医保部门和药商.通过对各方利益者的深入分析,提出了政策实施中应注意的关键问题.     

福建省连江县新型农村合作医疗支付方式改革的实证研究

目的针对连江县新型农村合作医疗(简称新农合)支付方式改革的做法,分析改革对主要利益相关者的影响,为均衡各方利益提出建议及措施。方法分析连江县新农合支付方式改革的方法,并运用利益相关者分析法,对改革中涉及到的主要利益相关者进行分析。结果 改革有利于减轻患者疾病经济负担,卫生服务供方对改革相对抵触,经办机构应该坚定对改革的立场,充分发挥经办机构作为第三方付费者的集体谈判能力。结论供方应该加强质量管理并接受需方的监督,管理方也应加强对供方医疗服务的监督和新农合费用的审核,同时加大对支付方式改革的宣传并开展与支付方式改革相配套的卫生改革。     

新型农村合作医疗制度实施过程中的问题及建议

新型农村合作医疗(简称新农合)制度是我国农村社会保障体系的重要组成部分,这一制度的实施不仅改善了农民的就医环境,而且也调整了政府、农村集体经济组织、农民个人及医疗服务机构等各方利益主体之间的关系。我国新农     

河南省新型农村合作医疗试点县卫生资源拥有量现况研究

通过对新型农村合作医疗试点县卫生资源状况的调查和分析，掌握河南省新型农村合作医疗试点县卫生资源的数量、结构、分布和使用效率，以及试点县卫生资源配置中存在的问题，为搞好卫生资源配置，给农民提供优质、足量、高效、适宜的卫生服务，保证新型农村合作医疗试点的成功提供政策建议，为评价新型农村合作医疗制度的效果提供基础资料。     

新型农村合作医疗大病保险政策各方利益主体间的博弈分析

目的:明确新型农村合作医疗大病保险各方利益主体间的博弈关系,为新型农村合作医疗大病保险政策的平稳有序推进提供理论参考。方法:运用博弈论对政府、商业保险机构、定点医疗机构和大病参合农民之间的博弈关系进行系统分析。结果:政府与商业保险机构之间、政府与定点医疗机构之间属于合作博弈,大病参合农民在博弈中倾向于选择合作策略。定点医疗机构与商业保险机构、大病参合农民之间倾向于非合作博弈。结论:商业保险机构与定点医疗机构应该迅速建立密切合作的战略关系。政府在加强对商业保险机构、定点医疗机构大病参合农民监管约束的同时,应尽快建立有效的激励机制。     

新型农村合作医疗的可持续发展研究

可持续发展研究是新型农村合作医疗理论研究和实践的迫切需要.明确政府责任是前提和基础,确保参合率是关键,合理利用卫生资源是重要环节.为此,需要加强管理,明确政府与参合农民在合作医疗制度中的责任;保障制度的公平性,增强吸引力;加强医疗服务机构监管,科学合理地使用卫生资源;制定相关法律把新型农村合作医疗纳入法制轨道.     

新型农村合作医疗：主要挑战和政策建议

本文基于面板调查数据，描述了新型农村合作医疗在我国农村地区的实施进展，以及该政策在实施过程中取得的成就和面临的挑战。结果表明，新型农村合作医疗在覆盖面、参合率、政策设计、筹资水平等方面成绩显著，但是，2007年参合农民对新型农村合作医疗的补偿政策的认知水平还非常低；新型农村合作医疗对参合患者的补偿水平不高，对大病患者的财务风险保护能力非常弱。而同时，医疗服务机构的不当激励可能已经损害了参合农民的利益。基于以上研究结论，本文在最后提出了相关政策建议。     

The mental health care reform debate: A content analysis of position papers

Traditional and ethnographic content analyses of 23 position papers on mental health care reform issued during 1993 yield a comprehensive overview of the specific subjects and broad policy issues that were of concern at that time. Five concrete aspects of mental health service delivery systems and eight policy issues were identified as most important in position papers by service provider organizations and advocacy groups. These analyses identified overall similarities in the content of the position papers, although interesting differences among organizations emerged. The analyses also identified a measure of the quality of policy discussions that is derived from comparing the frequency of concrete references to aspects of mental health care with references to broader policy issues.     

Barriers and Facilitators to Civic Engagement Among Elderly African Immigrants in Oslo

The numbers of elderly immigrants are increasing in Norway and their participation in civic activities is recognized to be crucial to their health and wellbeing. A qualitative study of 24 African immigrants aged 50 years and over was carried out in Oslo. Semi-structured interviews were used to explore barriers and facilitators to civic engagement among elderly African immigrants. The study discovered a number of barriers to participation of elderly immigrants in civic organizations. These barriers include poor health conditions, lack of information about relevant organizations, language difficulties and mistrust towards organizations. The elderly immigrants also pointed to the effectiveness of organizations in addressing community issues as a factor motivating their civic engagement. We argue that the barriers identified by this study pose challenges to achieving Norwegian policy goals of integration and Norwegian policy for active ageing. Hence, there is a need for service providers and policy makers to ensure voluntary organizations address those barriers effectively.     

卫生部门治理:战略与机制

在将健康作为一个要素融入所有政府部门与社会团体政策制定中的大健康整合战略下,政府各部门及社会团体在共识基础上形成广泛性治理目标,由政府主导卫生系统的运行,通过加强政府各部门间及与社会组织的协调与合作,统筹卫生系统的服务及管理功能,建立社会参与的绩效问责机制,实现提升卫生部门治理水平,改善社会健康结果的目标。     

山东省城市社区卫生服务机构效率评价

目的:分析山东省城市社区卫生服务机构的投入、产出情况,为社区卫生服务机构优化资源配置提供政策依据。方法:采用随机抽样的方法选择山东省27个城市社区卫生服务机构,采用C2R模型对投入产出指标进行数据包络分析(DEA)。结果:27所社区卫生服务机构中,13所DEA有效,有效率为48.19%。投影分析显示,14所非DEA有效的社区卫生机构如果通过改进和优化转变为DEA有效,固定资产总投资可减少508.96万元,总支出每年减少135.89万元,减少职工总数8人;总收入每年增加13.15万元,医疗服务总量增加240 691单位,公共卫生服务总量增加70 250.93单位。结论:山东省有超过一半的社区卫生服务机构都存在效率相对不足,提高这部分社区卫生服务机构的服务效率,可节约卫生资源投入,提高卫生服务产出,优化卫生资源配置。     

从镇江社区医保政策看社区卫生服务的改革方向

社区卫生服务与社会医疗保险制度相结合是“人人享有基本医疗卫生服务”的关键举措。本文通过总结分析镇江市医保与社区卫生服务融合互动发展的经验,提出了在推动社区卫生服务发展和改革方面所需要关注的政策风险应对、社区首诊制推行、基本服务功能发挥、社区平台利用、向健康保险过渡和社会力量参与的讨论与思考。     

A Population Health Impact Pyramid for Health Care

Policy Points

• To meaningfully impact population health and health equity, health care organizations must take a multipronged approach that ranges from education to advocacy, recognizing that more impactful efforts are often more complex or resource intensive.
• Given that population health is advanced in communities and not doctors’ offices, health care organizations must use their advocacy voices in service of population health policy, not just health care policy.
• Foundational to all population health and health equity efforts are authentic community partnerships and a commitment to demonstrating health care organizations are worthy of their communities’ trust.

     

浙江三地城市居民社区卫生服务需求与利用评价

目的 评价社区卫生服务（CHS）需求与利用，为提高社区卫生服务质量提供依据。方法 采用典型抽样调查方法对浙江三地的896名社区居民进行入户问卷调查。结果 三地居民65岁以上人口占10．4％；两周患病人群就诊流向为CHS机构的比例为18.3％。CHS机构知晓率为76．2％；CHS机构利用率为34．6％，获得的服务主要是医疗和购药的占413％；对医务人员水平不放心是不选择利用社区卫生服务机构的首位原因，了解个人健康档案的社区居民比例为10，5％。结论 （1）加强自我发展能力建设是发展社区卫生服务的关键；（2）开展预防保健服务是社区卫生服务工作的重点。     

Physician attitudes toward confidentiality of treatment for adolescents: findings from the Upper Midwest Regional Physicians Survey.

The provision of confidential medical services to adolescents is an enduring health policy issue in the United States, and the focus of policy statements by several professional medical organizations. Physician attitudes toward confidential service provision to teenagers were examined in the Upper Midwest Regional Physician Survey, a representative sample of community-based pediatricians and family physicians. Overall, three-quarters of participants favored confidential service provision for youths. Multivariate analysis revealed that the most salient reasons for favoring confidentiality were perception of unique needs among adolescents, year of licensure, high self-assessed competency in addressing sexual concerns of adolescence, adequacy of training in interpersonal and sexual issues, frequency of addressing interpersonal issues, and lower self-assessed adequacy of training in traditional medical problems of youths. Implications for state and federal legislation are discussed.     

Decreasing the Supply of and Demand for Guns: Oakland’s Youth Advocacy Project

This paper is a case study of how Youth ALIVE!, a nonprofit public health organization, blended direct service and policy goals to reduce youth gun violence at a time when guns became the number one killer of children in California. Youth ALIVE! trained young people living in California communities with the highest rates of gun violence to become peer educators and leaders to reduce both the supply of, and demand for, guns. The youth presented health and criminal justice data in the context of their own experiences living in communities endangered by gun violence to help build public policy solutions, contributing to the subsequent drop in gun homicides. Youth ALIVE’s vibrant grassroots model provides a real-life tableau of research and direct services working together to yield realistic policy solutions to a lethal public health problem. The youths’ successes demonstrate how nonprofit direct service organizations are uniquely positioned to advocate for policy and regulatory changes that can be beneficial to both program participants and society. Direct service organizations’ daily exposure to real-life client needs provides valuable insights for developing viable policies—plus highly motivated advocates. When backed by scientific findings on the causes of the problem, this synergy of youth participant engagement in civil society can promote good policy and build healthy communities.     

Diffusion of innovations in service organizations: systematic review and recommendations

This article summarizes an extensive literature review addressing the question, How can we spread and sustain innovations in health service delivery and organization? It considers both content (defining and measuring the diffusion of innovation in organizations) and process (reviewing the literature in a systematic and reproducible way). This article discusses (1) a parsimonious and evidence-based model for considering the diffusion of innovations in health service organizations, (2) clear knowledge gaps where further research should be focused, and (3) a robust and transferable methodology for systematically reviewing health service policy and management. Both the model and the method should be tested more widely in a range of contexts.