试析卫生经济改革活动中三项基础性工作

卫生经济改革是卫生改革的重要组成部分。在当前及今后所要解决的卫生问题中,其中加强农村卫生和预防保健工作、完善医疗保障制度、解决卫生资源投入不足和浪费并存、医药费呈不合理增长等问题,与卫生经济改革有直接和密切的关系。为解决这些问题,中央提出今后卫生经济改革的方针和政策,明确了卫生经济改革的方向,确定了卫生经济改革的重点。通过学习《中共中央、国务院关于卫生改革和发展的决定》(以下简称《决定》),笔者认为,在卫生经济改革中,有三项基础性工作,即区域卫生规划、基本卫生服务的界定和卫生服务成本核算,将贯穿于卫生经济改…     

中国卫生改革与震后重建战略同步

不少决策者最初认为汶川大地震会阻碍中国卫生改革进程，但事实上，针对地震的应急反应和灾后重建为加速卫生体制改革营造了一个机遇。更重要的是，可以利用这个机会在四川和周边省份建立更好的卫生体系。但是，新近颁布的四川地震灾区重建规划关注重点是基础设施。笔者认为更好的做法或许是在重建的同时有效解决卫生行业目前面临的主要问题，即政策协调和实施、制定规制及执行、筹资与治理。与卫生改革宗旨协调一致的卫生重建方案至少应包括三个方面：实现医保全民覆盖、加强初级卫生服务和公共卫生服务、改革基本医疗卫生服务提供体系。     

华东卫生经济研究协作会第14次年会特记

1998年10月17～19日，来自华东6省1市的80多位代表，相聚在福建省武夷山市，出席华东卫生经济研究协作会第14次年会。中国卫生经济学会副会长赵竹岩，中国卫生经济学会副会长、上海市卫生局副局长王龙兴，福建省卫生厅副厅长扬平，浙江省卫生厅副厅长陈晓非以及老领导王道民、计克良、邵浩奇、张玉龙等莅临大会并讲话。这次年会的中心议题是，在十五大精神指引下，深化卫生改革。会议就以下问题，展开了热烈的讨论。1关于卫生改革问题代表们认为，医疗卫生作为国民经济的第三产业，应当以十五大精神为指针，积极探索卫生事业公有制的实现形…     

对中国医院院长在当前卫生改革中所关注问题的分析

目的：研究中国医院院长在当前卫生改革中所关注的问题。方法：在2001年8月，通过问卷的形式对75名中国医院院长进行了调查，并对调查结果进行了分类和排序。结果：主要的问题依次是人事制度、职业培训、医院管理、奖金计算和工资以及提高医院的收入。结论：中国医院院长们愿意接受卫生改革的挑战，他们没有向国家索取经济补贴来维持现状，而是要求给予改革卫生体制所必需的权力，为中国医疗卫生事业创造更美好的未来。     

普及基本卫生服务应成卫生改革发展愿景

中国卫生经济网络成立15周年暨中国卫生改革与发展蓝图研讨会日前在北京举行。中国卫生经济网络政策研究委员会专家提出，中国需要建立卫生改革和发展的蓝图，从根本上解决卫生事业存在的问题。专家提出国家应将“普及基本卫生服务”作为愿景，将普及基本卫生服务与普及九年义务教育一起，共同构成国家最主要的社会政策。     

共绘中国卫生改革与发展蓝图——中国卫生经济网络成立十五周年暨中国卫生改革与发展蓝图研讨会侧记

2006年6月22-23日，中国卫生经济培训与研究网络（以下简称网络）成立十五周年暨中国卫生改革与发展蓝图研讨会在北京隆重召开，卫生部各司局及有关单位、国务院有关部委、部分省市卫生厅局的领导出席了会议；来自国务院发展研究中心等机构的专家、网络28个成员单位的代表、世界银行等国际组织的代表200余人共聚一堂，庆祝网络成立15周年。与会代表回顾了网络发展15年的历史，充分肯定了其所取得的成绩，认为：作为卫生部的智囊团之一，网络本着“为政府服务”的宗旨，积极开展课题研究和对卫生管理干部、师资的培训，有力地推动了中国卫生事业的改革和发展。会议还对为网络成长和发展作出贡献的有关人士进行了表彰。     

把医改进行到底

党的十七大报告指出，改革开放作为一场新的伟大革命，不可能一帆风顺，也不可能一蹴而就。 卫生改革是中国其产党领导的这场新的伟大革命不可分割的组成部分。我一直认为，从1997年全国卫生大会决定开始的卫生改革大方向完全正确，尽管操作上有些问题，行动上有些滞后，但决不是不成功的。     

卫生部政法司举办第二期卫生筹资与健康公平研讨会

为引导卫生政策制定者、执行者和研究者重视关于卫生筹资与健康公平问题，理解中国卫生改革及筹资现状，加强卫生相关部门对贫困人口卫生筹资问题的理解与交流，卫生部卫生政策法规司委托卫生部人才交流服务中心于2008年5月28-30日在北京举办了“中国卫生政策支持项目（HPSP）第二期卫生筹资与健康公平研讨会”。     

关于卫生改革的政策建议

《中国卫生产业》创刊已两周年，围绕卫生改革刊载了大量文章，体现了改革政策的制定者、研究者、实施者和受益者各自的意见、体会和心声。在卫生改革讨论正酣的当下，笔者将这些意见再度疏理，并结合自身的认识和体会，形成了以下建议，以期能对卫生政策的调整有所帮助．     

正确处理卫生改革与发展中的十大关系促进卫生事业全面、协调、可持续发展

当前，随着卫生改革的不断深入，体制、机制性深层次的矛盾和问题逐步显现。如何妥善处理卫生改革与发展中各方面的矛盾和关系，促进卫生事业健康持续发展，成为摆在各级卫生行政部门和卫生管理者面前的首要问题。新一届党和国家领导人提出了“以人为本，全面、协调、可持续发展”的科学发展观，因此，卫生系统要牢固树立和落实科学的发展观，正确处理卫生改革与发展中的十大关系。     

2006:我国医改的转折点

2006年我国医改确立了“政府主导”的指导原则,这是我国医疗卫生发展的重要转折点。医改方向的转变,源于我国改革指导思想的发展,源于对20多年来改革经验教训的总结,源于应对一系列社会矛盾的需要,也标志着我国经济社会发展已进入了一个新的阶段。2006年对医改的争论更加广泛深入,主要的话题包括宿迁医改评价、医疗体制模式的选择以及“全民医保”的可行性等,这些争论深化了人们对医改的思考,为新方案的出台提供了正反两方面的借鉴。同时,平价医院、社区医疗以及新农合等改革措施扩大试点为新一轮的医改提供了重要基础。     

Bridging the gap between education and practice in public health, with particular reference to less-developed provinces in China

Ongoing healthcare system reform is one of the most important issues in China. There is an increasing awareness that public health education should be reformed to meet the demands of public health practice. This paper summarizes the current status of increasing public healthcare demand and public health service capacity in China, especially in less-developed provinces, and introduces the current public health educational system and public health administration structure. The paper also provides evidence for a considerable gap between public health education and practice, and suggests possible measures to bridge the gap.     

医院制度创新的探讨

文章探讨了医院制度创新的涵义与意义，同制度创新是医院其它所有创新的基础和前提，我国医院制度创新更为迫切和重要。文章还分析了我国医院制度创新存在的主要问题：各自为政的行业管理；政府对医院的管理职能不清；医院内部改革不足。针对上述问题，提出了我国医院制度创新的对策：实行医疗服务全行业统一管理；转变卫生行政管理职能，逐步实行“管”、“办”分离；重庆抓好医院内部改革。     

卫生财政学概念的涵义、范围领域、基本特征与地位作用(上)

我国的医药卫生体制改革总体方案设计正处于关键时期．卫生筹资模式、卫生总费用构成状况和政府在卫生保健服务中承担的责任是当前的核心议题，卫生财政和卫生财政学应运而生卫生财政（包括医疗财政）是财政体制创新的必然结果，是财政体制处于由以分税制为基础的分级财政体制向公共财政体制转型的过渡性产物，通过简要讨论卫生财政概念及其内涵、外延，描述卫生财政学的学科体系．确定卫生财政学的研究范围、研究领域和关键性研究议题，概括卫生财政的基本特征和国际发展历史经验．分析卫生财政的基本功能与地位作用等基础理论政策议题，为医药卫生体制改革和构建和谐社会、和谐医惠关系提供了崭新的改革思路。     

Home care in Canada

This is an overview of the home care sector's evolution in Canada, including current models and delivery structures, funding, eligibility criteria, and services provided. Cost escalations of the traditional healthcare system and a reduction in federal funding has driven health reform in Canada. This has been accompanied by a major but sporadic expansion of the home care sector across the country. For the home care sector to develop in a more rational, cost-effective and client-focused manner, the development of common standards, a common database and programme evaluation will be required. This will also be necessary for political, planning, and administrative officials to understand and justify the reallocation of resources from institutional to community health sectors. Addressing issues such as the impact of health reform, the role of the private sector, realignment of system incentives, and developing effective partnerships with hospitals is critical if home care is to be recognized as an essential, cost-effective component in Canada's healthcare system.     

Achievement of equity and universal access in China's health service: A commentary on the historical reform perspective from the UK National Health Service

Abstract

This paper aims to examine the UK National Health Service (NHS) in the historical context of its background reforms and to investigate future developmental strategies for China's health system. We focus on the central issues facing China's future healthcare development: equity and access. China and the UK have approached healthcare reform from opposite perspectives, the NHS has maintained the core principle of providing universal health coverage throughout the decades. However, due to increasing demand, reforms to improve and sustain efficiency have meant increasing government funding while introducing elements of a market system. Conversely, China has moved from a centrally planned system to a fee-for-service system, but serious problems of inequity and access call for new methods of organisation and financing. With the future of both systems under constant debate, international experience will play a vital role in formulating health system reform strategies.     

The economics of primary healthcare reform in Australia - towards single fundholding through development of primary care organisations

Objective: A strong primary care sector is widely acknowledged as a fundamental component of a well functioning health system and thus has been the focus of strategic reforms in a number of countries. This paper provides an economic analysis of primary healthcare reform, with the aim of identifying the key structural elements that are necessary to support enhanced models of primary health in the Australian context. Approach: This paper utilises economic theory, and draws upon empirical evidence and international experience to analyse primary healthcare reform to identify the structural elements necessary for an enhanced primary care sector. The aim of which is to improve health system performance. These structural elements are then critically examined in the Australian health system setting. Conclusion: For enhanced models of primary healthcare to promote efficiency, they must incorporate a number of key structural elements; notably: governance and purchasing responsibilities for primary care devolved to a meso‐level organisational structure through capitated single fundholding arrangements; blended payment methods for reimbursing providers; the establishment of a national quality and performance framework; and the development of primary care infrastructure. Implications: As the Federal government attempts to address recommendations of the National Health and Hospital Reform Commission, a window of opportunity now exists to pursue long overdue structural reforms to deal with the challenges facing the Australian health system. The paper advances the important structural features to primary healthcare that need to be embraced as the government attempts to pursue its health reform agenda.     

Global implications of China's healthcare reform

The ongoing healthcare reform in China has a powerful spillover effect beyond the health sector and the borders of China. A successful completion of the Chinese reform will offer a new model for social justice development, shift the global economy toward sustainability and create a new hub for science and technology in medical and health science. However, reforming the healthcare system in the most populated country is a daunting task. China will not live up to its promise, and all the potentials may end with hype not hope if coherent national strategies are not constructed and state‐of‐the‐art navigation is not achieved with staggering domestic and global challenges. The cost of failure will be immensely high, socioeconomic costs for Chinese and an opportunity cost for the world as a whole. A full appreciation of the global implications of China's healthcare reform is crucial in keeping China receptive toward good practices evidence‐approved elsewhere and open minded to fulfill its international obligations. More critically, the appreciation yields constructive engagements from global community toward a joint development and global prosperity. The current report provides a multiple disciplinary assessment on the global implications of the healthcare reform in China. Copyright © 2014 John Wiley & Sons, Ltd.     

什么是"好"的卫生政策

医药卫生体制改革已进入攻坚和关键阶段,宏观、前瞻、科学的卫生政策指导与深厚社会关怀、社会健康理论支持已成为继续深化卫生体制改革发展战略措施和战略议题。如何科学民主决策,如何创造性地制定优秀的卫生政策框架,是卫生改革发展成功的前提。