From home,to market,to headquarters,to home. Relocating health services planning and purchasing in New Zealand

Health sector restructuring has been in vogue, but no country has engaged in as much health sector restructuring as New Zealand where, in a decade, there have been four different public health sector structures. This article discusses New Zealand's four structures with an emphasis on relocating the critical functions of health care planning and purchasing, and on the development of the present district health board system. The four structures include: an area health board system (1989-1991) with planning and purchasing located at "home" in local areas and closely aligned with service provision; a competitive internal market system (1993-1996) which separated planning and purchasing from service provision; a centralised system with a "headquarters" controlling planning and purchasing (1997-1999) while maintaining the distance from provision; and the district health board system currently under development (1999-) which sees purchasing and planning sent home again to regions and linked closely with service provision. The present system entails the devolution of considerable responsibility to the local level, within a framework of strong central government control. Based on New Zealand's experience, the article notes that all but the market structure appear to have provided an adequate environment for effective health care planning and purchasing.     

试论伤寒论中的寒、热、邪

<伤寒论>广泛应用寒、热二字来描述病因、病性、病机,很少用寒、热来描述治则治法,譬如"热者寒之,寒者热之"等未见.文中亦少用"邪"字来描述病因.在文中,寒热有时未取其本义,而是代指邪气,代言致病因素,有时热意反为寒,有时寒意反为热,这不能仅用<内经>、<难经>理论去理解,还要结合上下文及方药来推断.了解这一点,有利于我们学习和研究<伤寒论>原文及临床应用.     

Attitude to telemedicine, and willingness to use it, in audiology patients

We studied the willingness of patients to use telemedicine for ear- and hearing-related appointments, and the factors that influenced their decision to participate in telemedicine. A survey was designed with questions about patient appointments, perceived advantages and barriers to telemedicine, and prior use of the Internet for health-related matters. A total of 116 patients in four audiology centres were surveyed from December 2004 to May 2005. There were 54 male and 62 female respondents; 46% of the participants were aged over 66 years. In all, 75% had not previously heard of telemedicine. The most common reasons for willingness to use telemedicine were to reduce the time waiting for an appointment and cost. The most common barrier to using telemedicine was a preference for face-to-face visits. Of those surveyed, 32% were willing to use telemedicine, 10% would sometimes be willing, 28% were unsure, and 30% were not willing. There was no relationship between willingness and age or gender, except that women over the age of 55 years were less willing. Patients who had previously heard of telemedicine and used the Internet for health-related matters, especially men, were more inclined to have a telemedicine appointment.