不同管理体制下城乡居民基本医疗保险运行效果比较——来自苏州市的实证分析

目的：实证分析不同管理体制下城乡居民基本医疗保险的运行效果。方法：以苏州市下辖的常熟市及其他三个县级市作为研究对象,运用描述性统计和比较分析的方法分析城乡居民基本医疗保险运行情况。结果：与其他三个县级市相比较,常熟市参保人员利用市外住院服务比例较低,城乡居民医保住院统筹基金流向市外医疗机构的比例较低,住院补偿受益率相对较高,参保患者的自付住院费用较低,但住院实际补偿比较低。结论：医保的管理体制未对医保覆盖面和基金运行产生明显影响;卫生部门主管有助于更好地坚持“保基本、强基层、建机制”的原则,可以更好地控制医疗费用的上涨速度,减轻患者的医疗负担。建议：进一步扩大医保管理体制改革的试点,为完善我国医保管理体制提供更多的实证依据;同时注重控制医药费用的上涨速度,以降低参保人员的医疗负担;建立健全城乡居民基本医疗保险的评价指标。     

我国与世界一流肿瘤科技社团的发展机制比较

建设世界一流科技社团是中国科协提出的改革理念。本文以肿瘤科技社团为研究对象,选取中国抗癌协会、美国临床肿瘤学会、美国癌症研究学会和国际抗癌联盟四家有代表性的单位,通过文献研究、比较分析法从外部环境和内部治理两方面探究国内外肿瘤科技社团在运行模式和治理体制上存在的共性和差异性,并基于此探寻我国建设世界一流肿瘤科技社团的可行路径。     

贫困县卫生规划增量博弈下的政策变通与政策执行

随着新医改、健康中国2030规划以及"十三五"健康扶贫工程的推进,贫困县持续获益,但农村卫生系统可持续发展终究要变"输血"为"造血",这需要从卫生规划到治理常态机制的结构性变革。随着中央对农村卫生投资重点的抓大放小、增量发展的抑公促私,贫困县"十三五"卫生规划制定过程充满了博弈、抉择和变通。对西部4个国家级贫困县访谈调研发现,贫困县卫生规划偏好"上项目—拉投资",呈现出资源规划的增量投机和保守治理等特点。贫困县卫生规划除了要平衡公共利益和部门利益之外,纵向问责控制结构、引民资促发展思路也影响着贫困县卫生规划与治理。     

英国国民卫生服务制度(NHS)的结构性改革与治理模式

基于英国NHS在管理体制与机制上所实施的结构性改革措施,从完善法律、建立问责机制、完善财务管理和经营模式4个维度,系统阐述了NHS的结构性改革与治理模式的特点;作为一种"公共利益公司",NHS所属公立医院基于公私伙伴关系的原则,在坚持公益性的前提下,引入企业经营行为组建了信托基金医疗联合体,并根据NHS的核心原则,免费医疗、需求导向、可负担性等,基于购买合同向辖区患者或居民提供医疗保健服务。随着相关改革措施的逐步实施,NHS信托基金医疗联合体的法人地位和自主决策权得到明显提升,能真正做到对自身的发展负责;同时,随着对提供者行为的规范,以及医疗服务市场竞争与规制机制的完善,也极大的促进了医疗机构之间的有序竞争和医疗服务供给的多元化发展。     

Thoroughfares,crossroads and cul-de-sacs: Drug testing of welfare recipients

Over the past five years, proposals to introduce drug testing for welfare recipients have proliferated across the globe. In England, it was included in the Welfare Reform Act 2009 (yet never implemented) and in 2013, the New Zealand government introduced legislation which requires claimants to take pre-employment drug tests when requested by a prospective employer or training provider. Similarly, in over 20 US states there have been attempts to initiate drug testing of welfare recipients as a condition of eligibility for welfare, although frequently these controversial plans have either stalled or once introduced they have been halted through legal challenge.This article examines the process of introducing drug testing of welfare claimants in the UK as part of a broader strategy to address worklessness among problem drug users. Using Hudson and Lowe's (2004) multi-level analytic framework, which disputes ‘top down’ rational models of policy-making, it explores the mechanisms used for challenging drug testing policies. In so doing, it identifies the key policy actors involved, noting the alliances forged and strategies adopted to persuade the government to pursue alternative policies. Whilst the primary focus of the article is on the UK, consideration of the US and New Zealand facilitates comparison of the types of policy networks which emerge to oppose similar policies proposed in different socio-political contexts, and the forms of argument and/or evidence they inject into policy discussions. It is argued that a heavy reliance on rights-based arguments was a feature of opposing drug testing in the UK, US and New Zealand, and these featured more heavily than attempts to refute evidence underpinning these policies. However, there were important differences between jurisdictions in relation to the mechanisms used to challenge drug testing policies. These do not simply reflect the nature of the policies proposed but instead are reflective of different modes of governance, which influence the character of the policy networks formed and their judgements about the most effective ways of opposing what they regard as essentially flawed policies.     

Governance in non-for-profit hospitals: Effects of board members’ remuneration and expertise on CEO compensation

Although hospitals vary in terms of their governance structures, little research has focused on the effectiveness of these governance mechanisms through the study of executive contracting. Using a sample of 80 non-for-profit private hospitals in the Netherlands, I investigate whether differences in governance structures of hospitals are informative for explaining the variations in chief executive pay. After controlling for important economic determinants of CEO compensation in hospitals (i.e., type and size of the hospital, CEO type and job complexity, market conditions and performance attributes), the results suggest that CEOs on average earn more (1) when the hospital's supervisory board members receive more remuneration (a higher absolute as well as an excessive remuneration) and (2) when supervisory board members have a lower level of expertise. The findings suggest that supervisory boards are more effective in controlling agency problems (i.e., aligning CEO pay to economic conditions) when their members have more expertise, but at the same time that the monitoring function is hampered when supervisory board members receive a large (excessive) remuneration.     

The role of evidence and the expert in contemporary processes of governance: The case of opioid substitution treatment policy in England

BackgroundThis paper is based on research examining stakeholder involvement in substitution treatment policy which was undertaken as part of the EU funded FP7 ALICE-RAP (Addictions and Lifestyles in Contemporary Europe – Reframing Addictions Project). In England, the research coincided with a policy shift towards a recovery orientated drug treatment framework and a heated debate surrounding the role of substitute prescribing. The study aimed to explore the various influences on the development of the new ‘recovery’ policy from the perspectives of the key stakeholders involved.MethodsThe paper is based on documentary analyses and key informant interviews with a range of stakeholders, including representatives of user organisations, treatment providers, civil servants, and members of expert committees.ResultsDrawing on the theoretical insights offered by Backstrand's ‘civic science’ framework, the changing role of evidence and the position of experts in the processes of drugs policy governance are explored. ‘Evidence’ was used to problematise the issue of substitution treatment and employed to legitimise, justify and construct arguments around the possible directions of policy and practice. Conflicting beliefs about drug treatment and about motivation for policy change emerge in the argumentation, illustrating tensions in the governance of drug treatment and the power differentials separating different groups of stakeholders. Their role in the production of evidence also illustrates issues of power regarding the definition and development of ‘usable knowledge’. There were various attempts at greater representation of different forms of evidence and participation by a wider group of stakeholders in the debates surrounding substitution treatment. However, key national and international experts and the appointment of specialist committees continued to play dominant roles in building consensus and translating scientific evidence into policy discourse.ConclusionSubstitution treatment policy has witnessed a challenge to the dominance of ‘scientific evidence’ within policy decision making, but in the absence of alternative evidence with an acceptable credibility and legitimacy base, traditional notions of what constitutes evidence based policy persist and there is a continuing lack of recognition of ‘civic science’.     

政府与公立医院院长权责划分研究

通过梳理我国公立医院权责体系现状,分析政府和公立医院院长权责划分中存在的问题及对院长行为的影响,认为目前政府与公立医院权责划分存在诸多问题,无法保证公立医院院长完成政府赋予的职责,影响到政府举办公立医院目标的实现。建议根据权力产生的激励作用考虑权力的归属问题,重新配置或调整政府与公立医院院长的相关权力;通过制定法律或单一政策文件或与院长的委托代理合同,详尽规定公立医院的相关权力,并明确权力归属;规定剩余控制权归政府所有;同时建立有效的问责机制,改变目前对公立医院院长激励和约束失衡的状况。     

What can transaction costs tell us about governance in the delivery of large scale HIV prevention programmes in southern India?

This paper aims to understand the transaction costs implications of two different governance modes for large scale contracting of HIV prevention services to non-governmental organisations (NGOs) in 2 states in India as part of the National AIDS Control Programme between 2001 and 2003. Interviews at purposively selected case study NGOs, contracting agencies and key informants as well as document review were used to compile qualitative data and make comparisons between the states on five themes theoretically proposed to shape transaction costs: institutional environment, informational problems, opportunism, scale of activity and asset specificity (the degree to which investments made specifically for the contract have value elsewhere). The State AIDS Control Society (SACS) in state Y used a management agency to manage the NGO contracts whereas the SACS in state X contracted directly with the NGOs. A high level of uncertainty, endemic corruption and weak information systems served to weaken the contractual relationships in both states. The management agency in state Y enabled the development of a strong NGO network, greater transparency and control over corrupt practises than the contract model in state X. State X's contractual process was further weakened by inadequate human resources. The application of the transaction cost framework to contracting out public services to NGOs identified the key costs associated with the governance of HIV prevention services through NGO contracts in India. A more successful form of relational contract evolved within the network of the contract management agency and the NGOs. This led to improved flows of information and perceived quality, and limited corrupt practises. It is unlikely that the SACS on its own, with broader responsibilities and limited autonomy can achieve the same ends. The management agency approach therefore appears to be both transaction cost reducing and better able to cope with the large scale of these contracting programmes.     

落实党委领导下的院长负责制的实践与思考

党委领导下的院长负责制是国家建立现代医院管理制度、深化公立医院改革的重大举措。文章总结归纳了复旦大学附属华山医院运用组织行为学理论,从管理层次和管理幅度两个维度对管理体制进行重构的实践经验,探讨了如何充分发挥党委领导的核心和引领作用,将党的领导融入医院治理各环节,为其他公立医院开展相关工作提供了参考。