从行政管理到治理:当代卫生管理的必由之路

随着卫生改革的进行,卫生领域产生了各种具有独立利益的行动主体。在很多行动情境中,它们与卫生行政部门之间都不具有行政权力上的隶属关系,因此需要卫生行政部门运用治理理论对卫生事业的发展实施管理。为了有效参与治理,卫生行政部门既要从治理的"术"和"权"入手提高自身的治理能力,又要帮助弱势行动主体提高行动能力以创造适合于治理的行动主体间结构。     

Regulating human genetics: The changing politics of biotechnology governance in the European Union

Human genetics poses new political issues for the governance systems of the EU and, in so doing, graphically illustrates the regulatory problematic of innovative health technologies (IHTs). Civil society, industry and the scientific community are registering new, and conflicting, political demands on the governance policy community of the EU. At the same time, the traditional reliance of that community on technocratic networks as the mainstay of policy formation and implementation is no longer a sufficient mechanism for maintaining the legitimacy of the process. New policy networks imbued with different value systems are rapidly making inroads into the previously impermeable policy community of EU governance. Recognising the limitations of the existing means for securing agreement to regulatory change, the institutions of the EU are adapting their stance, or stances, and seeking new methods of engagement both with the expanding numbers of NGOs in the human genetics arena and the public at large. To an extent, there is institutional competition between the departments of the European Commission, the Council of Ministers and, most particularly, the European Parliament for pole position in the business of policy agenda setting. Fuelled by the regulatory difficulties already experienced in biotechnology by GM foods and GM crops, that competition is rapidly causing a sea-change in the political culture of governance policy making at EU level.     

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。     

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。     

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。     

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。     

高值医用耗材定义与治理内涵研究

从医用耗材的定义和分类出发,梳理我国高值医用耗材采购治理、定价治理、全面综合治理三个阶段,提出如何界定“高价值”问题。结合相关定义及高值医用耗材分类,认为我国高值医用耗材内涵界定应考虑临床价值、经济价值和社会价值三个核心维度,从而为制定治理清单和开展科学治理提供参考。     

The post‐2015 landscape: vested interests,corporate social responsibility and public health advocacy

This paper explores the tensions between UN calls for private sector engagement in the post‐2015 landscape and public health opposition to those ‘harm industries’ that are ‘corporate vectors of disease’ for the mounting global non‐communicable disease burden. The UN's support for public‐private partnership has provided industries with ‘vested interests’ in the propagation of unhealthy behaviours with new opportunities for the strategic alignment of their corporate social responsibility (CSR) endeavours with the post‐2015 sustainable development agenda. This has galvanised public health advocates to place pressure on the World Health Organisation to formalise their ambiguous stance towards private sector involvement in public policy formation and the resultant ‘conflicts of interest’. This paper critically examines the ‘gathering storm’ between this ‘anti‐corporate movement’ and the alcohol industry in the increasingly politicised domain of CSR. Drawing on the example of SABMiller's Tavern Intervention Program, the paper argues that CSR represents a profound threat to the sanctity and moral authority of the public health worldview. Questions therefore need to be asked about whether the public health‐led path of industry non‐association will necessarily result in health improvements or just a further retrenchment of the ideological faultlines explored in the paper.     

Shared Governance within the market-oriented health care system of New Zealand

The New Zealand health reforms, announced in 1991 and implemented over the 3-year period 1992-1994, were market-oriented, following a competitive model that had been applied across New Zealand's public sector. Consideration is given to the effects of the health reforms on nursing and midwifery at Capital Coast Health Limited (CCHL), with the introduction of a market/economic model of health care and its accompanying managerialism. The market model, or the economic era of health care, as some describe it, created an environment where nurses felt powerless. All the directors of nursing and on-going hospital educational programs were disestablished in the public sector; nurses were disheartened, confused and lacked representation at senior management. Integral to, and accompanying, corporatization is managerialism. With corporatization, came managers from the non-health care sector who had no understanding of the complexities of health care. Accompanying managerialism is the notion that any able manager was capable of managing any agency, whether public or private. Naturally, there was an underlying conflict between the caring relationships and their related work in the clinical environment, and the desire for efficiency and economy. It seemed that we were dealing with contrasting themes of 'the market' and 'humanity' This led to further confusion and disempowerment, as the dollar gained prominence, for nursing has always been grounded in the 'humanities'. It was into this environment, after 5 years of the health reforms, that a Nurse Executive was appointed and the concept of Shared Governance was introduced. This article describes why Shared Governance was considered an appropriate model to introduce at CCHL, and identifies some of the tangible benefits being realized 18 months post implementation. Discovering that membership in cross-organizational teams provides a mechanism for networking and creating a broader understanding of the organization has been but one of the major benefits.     

专利药医保准入谈判治理中政府领导力的建构研究

专利药医保准入谈判是治理体系现代化战略在医药卫生领域的重要突破,多元治理主体的加入非但没有削弱政府的重要性,反而赋予了政府作为治理体系"领导者"以更加丰富的内涵。本文整合了已有治理理论模型中关于领导者功能的论述,以其领导力发挥的内在机制为线索,创新性地构建了领导力分析的理论框架。基于专利药医保准入谈判治理的实质,本文结合典型国家的实践经验分析了政府领导力建构的模块和路径,一是提出和选择治理制度,包括药品价格谈判的启动机制与价值评估标准;二是选择治理主体并管理冲突,包括谈判博弈平台与风险共担机制的建设;三是确保治理过程的耦合协调,主要涉及与地方医保和临床使用的衔接。最后建议我国从行政性、适应性和赋能性三个层面继续加强专利药医保准入谈判治理中的政府领导力建设,以保证治理决策的公平与效率为前提,平衡潜在的利益冲突。