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1.
ObjectiveTo analyse the similarities and differences in the discourse surrounding the conceptualisation of health and the perceived health assets and needs in the neighborhoods and city of Bilbao in a participatory process.MethodParticipatory workshops were held with professionals, neighbors and associated citizens. The differences in perceptions of the three content blocks were analysed on the basis of the health model referred, as well as the typologies —of a more individual or structural nature— of identified health needs and assets.ResultsThe conceptualisation of health from a biopsychosocial perspective was clearer among professionals, although both profiles pointed to the importance of its social determinants. The formulation of needs and assets in health by the neighbors was made from the impact on their daily life and from a position of users with respect to a service provider administration. Among the associated citizens and professionals, intermediate and structural determinants were more frequently mentioned, as well as issues related to the administration's scope of action.ConclusionsThe inclusion of the multiplicity and diversity of perceptions in planning is key to good local government for health. To address their contradictions, a commitment by governments to effectively incorporate citizen participation is needed.  相似文献   
2.
本文基于多中心治理理论检视发现,现行的医疗保险运行机制存在基本医疗保险基金所有权与管理权分离、医疗保险政策改革只能"做加法"不能"做减法",其他相关利益主体缺位、改革无法满足多方诉求,医保经办主体动力和能力不足等问题。这些问题不仅导致医疗保险制度的可持续性面临严峻挑战,而且与实现全民统一医疗保险制度的目标渐行渐远。因此,在新时代背景下,为了构建权责清晰、保障适度、可持续发展的医疗保险制度,本文提出创新医疗保险公法人治理体制,完善中国特色医疗保险治理体系,同时推进社会保险公法人治理机制的创新,促进政府、市场与社会之间的协同与配合,最终实现推进国家治理体系和治理能力现代化的伟大目标。  相似文献   
3.
中国抗生素耐药性治理的政策演变及启示   总被引:1,自引:0,他引:1  
目的:本研究系统梳理了我国在不同时期实施的抗生素耐药性治理,分析政策的演变历程和原因,旨在为下一步政策制定提供启示。方法:在国家卫生健康委员会等相关部委的官方网站上,系统检索有关抗生素耐药性问题的政策文件,提取关键信息并梳理政策内容与时间节点,归纳和总结中国为应对抗生素耐药性问题所采取的政策和行动。结果:中国抗生素耐药性治理的政策演变过程可划分为三个阶段:以药品管控为主要治理策略的第一阶段,以临床监测为主要治理手段的第二阶段,多领域参与的全面治理策略的第三阶段。结论:为进一步解决抗生素耐药性问题,中国应加强社区感染控制和抗生素合理使用,加强对农业和环境领域的耐药性治理,建立基于"One Health"框架下的跨部门、跨学科合作平台,并加大抗生素替代药品的研发力度。  相似文献   
4.
Throughout the life course, oral diseases are some of the most common non-communicable diseases globally, and in Europe. Human resources for oral health are fundamental to healthcare systems in general and dentistry is no exception. As political and healthcare systems change, so do forms of governance. The aim of this paper is to examine human resources for oral health in Europe, against a workforce governance framework, using England as a case study. The findings suggest that neo-liberalist philosophies are leading to multiple forms of soft governance at professional, system, organisational and individual levels, most notably in England, where there is no longer professional self-regulation. Benefits include professional regulation of a wider cadre of human resources for oral health, reorientation of care towards evidence-informed practice including prevention, and consideration of care pathways for patients. Across Europe there has been significant professional collaboration in relation to quality standards in the education of dentists, following transnational policies permitting freedom of movement of health professionals; however, the distribution of dentists is inequitable. Challenges include facilitating employment of graduates to serve the needs and demands of the population in certain countries, together with governance of workforce production and migration across Europe. Integrated trans-European approaches to monitoring mobility and governance are urgently required.  相似文献   
5.
Many working hours of healthcare professionals are spent on administrative tasks. Administrative burden is caused by political choices, legislation, the requirements of health insurers and supervisors. Coordination between the parties involved, is lacking. Therefore, we studied to what extent sharing internal audit results of hospitals with external supervisors is possible and the necessary preconditions. We interviewed 42 individuals from six hospitals and the Dutch Health and Youth Care Inspectorate.The interviewees expressed that there is no coordination in timing and content between internal audits and external supervision. They were in favour of sharing internal audit results with external supervisors to reduce the supervisory burden. They stated that internal audits give insight into quality problems and improvements, how hospital directors govern quality and safety, and the culture of improvement within healthcare provider teams. With this information, the inspectorate can judge to what extent hospitals are learning organisations. The interviewees mentioned the following preconditions for sharing audit results: reliable and risk-based information about quality and safety, collected by expert, trained auditors, and careful use of this information by the inspectorate in order to maintain openness among audited healthcare professionals.In conclusion, internal audit results can be shared conditionally with external supervisors. When internal audit results show that hospitals are open, learning and self-reflecting organisations, the healthcare inspectorate can reduce their supervisory burden.  相似文献   
6.
Many key organizations have called attention to the importance of addressing workplace mental health. In this Open Forum piece, two academic psychiatrists present recommendations from their experiences providing psychiatric care in a corporate setting. A literature review using the PubMed database was performed. The search found no peer review articles that discuss the topic of employer-sponsored mental health services outside of traditional employee assistant programs. Based on first-hand experience, the authors of this forum describe key issues and best practices to ensure employer-sponsored mental health services are a successful treatment for patients and mental health providers alike.  相似文献   
7.
《Vaccine》2020,38(45):7118-7128
IntroductionToward the Global Vaccine Action Plan 2020 goal, almost 90% of countries have established a National Immunization Technical Advisory Group (NITAG). However, little is known about NITAG's contributions to governance.MethodsIn 2017–2018, a two-step, qualitative retrospective study was conducted. Jordan (JO), Argentina (AR), and South Africa (SA) were selected owing to government-financed NITAGs from middle-income countries (MICs), geographic diversity, and a vaccine introduction with NITAG support. Country case studies were developed, collecting data through desk review and face-to-face key informant interviews (KIIs) from Ministry of Health (MoH) and NITAG. Case studies were analyzed together, to assess governance applying the European Observatory on Health Systems and Policies framework focusing on transparency, accountability, participation, integrity, and policy capacity (TAPIC).ResultsDocument review and 53 KII (22 AR, 20 SA, 11 JO) showed NITAGs played a pivotal role as advisors promoting a culture of evidence-informed policies. NITAGs strengthened governance, although practices varied among countries. Meetings were conducted behind-closed-doors, participation restricted to members, only in one country agendas, and recommendations were public (AR). To increase participation, policy capacity, and transparency, countries considered adding experts in communications, advocacy, and economics. AR and SA contemplated including community members. NITAGs functioned autonomously from the government, with no established internal or external monitoring or supervision. NITAG meeting minutes allowed the review of integrity, adherence to terms of reference, standard operating procedures, and conflict of interest (CoI). For the most part, NITAGs abided by their mandates. Significant issues were related to the level of MoH support and oversight of CoI declaration and documentation.ConclusionsSystematically implementing governance approaches could improve processes, better tailor policies, and implementation. The long-term survival and resilience of NITAGs in these countries showed they play a significant role in strengthening governance. Lessons learned could be useful to those promoting country-driven evidence-informed decision-making.  相似文献   
8.
有效保障常用低价药品的供应,对于保障公众健康、维护社会公平以及顺利推进新医改都具有非常重要的意义。本文从公共治理理论中的治理工具分析角度出发,重点分析如何结合和优化多样化的政策工具的使用来综合确定常用低价药品的工具,即应用"志愿—强制—混合"治理工具分析框架,从志愿性(家庭与社区、志愿者、市场)、强制性(政府命令—控制型监管、成立公共企业、直接提供)和混合性治理工具(信息披露与规劝、补贴、产权拍卖、税收与使用者付费)等多个角度对保障常用低价药品的供给提出对策,最后提出了巧用价格杠杆、完善采购办法、建设药价信息披露机制以及确立政府补贴与产业政策战略四方面的具体政策建议,以此完善最近出台的相关最新政策内容,从而确立我国保障常用低价药品供应的总体战略。  相似文献   
9.
卫生资源优先次序分配作为政府有效治理的重要领域,在我国仍缺乏类似层面的综合思考。西方在该领域的研究趋势已从单纯的经济学思考走向了政治经济学、制度约束、卫生筹资的全面分析,并在更宏大的组织和政治情境中,考量政府的治理范围、手段,建构操作性强的优先次序分配框架。在卫生决策实践中,找寻跨学科工具的最佳组合考验着决策者的治理水平。本文梳理政治学、卫生经济学、哲学、法学、循证医学等不同学科对卫生资源优先次序分配的思考。最后明确政府卫生资源治理的层次、治理策略建议,强调卫生决策从"作为结构的治理"走向"作为过程的治理"的发展规律因应我国所面临的挑战。  相似文献   
10.
医师多点执业在各地广泛试点,也引起来了社会各界的关注。本文综述了近年来国内外对于医师多点执业的研究及管理办法,发现规制路径主要有完全禁止、直接限制、反向激励、行业自制和完全放开等;而规制手段则有经济手段、法律手段和放权等。经比较,认为医师多点执业具备能增加患者就医便捷度等正面效应,也会带来影响公立医院服务供给等负面效应,各类规制手段也都有前提条件。在我国应承认医师多点执业的积极效应,在综合评估各地执行条件的基础上,因地制宜地组合利用规制手段进行合理管理。  相似文献   
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