医患双方对公立医院公益性认知情况分析

在文献研究的基础上,对公立医院医护人员及就诊患者进行关于公立医院公益性认知情况的问卷调查,分析医患双方对公立医院公益性认知情况的差别,提出公立医院公益性的主要体现形式,提示制定相关的卫生政策,要综合考虑各方的利益,从而为促进我国公立医院公益性的回归,营造和谐的医患关系提供依据.     

公众对艾滋病患者的认知心理

艾滋病(AIDS)自1981年被发现后,已在全球肆虐蔓延,在我国也是保持着增长的流行趋势,截至2004年9月底,全国累计报告艾滋病病毒(HIV)感染者89 067例,此报告只是冰山一角.面对这么一个特殊的大群体,中国对HIV/AIDS罹患者的社会心理容忍、支持和关怀程度是低于罹患者本人社会心理支持需求的,这种强烈反差已成为目前我国社会公共卫生和精神障碍问题之一.公众对HIV/AIDS医学问题的社会认知水平普遍认识不高、心理认知不正确是产生偏见、歧视的社会根源.提高社会心理认知水平,促进社会对患者的心理支持,从心理学的角度指导公众关爱这个群体,正确对待AIDS病人,认识AIDS关传播知识,患者和公众齐心协力,使社会和谐发展,进而达到控制和预防AIDS的目的.     

What Are the Public Obligations to AIDS Patients?

The operating assumption in mostdiscussions of health policy is that governmenthas some responsibility for the health of itscitizens and that it may legitimately tax,subsidize, and regulate its citizens in theexercise of that responsibility. On thisassumption, public obligations to HIV/AIDSpatients are a function of their needs inrelationship to other health needs. This paperchallenges the operating assumption by arguingthat it cannot be grounded in the obligationsthat individuals have to each other.The paper rests on its own assumption: themoral theory of individualism. On this theory,individuals are ends in themselves who have theright to choose their own actions and uses oftheir resources; they do not have unchosenobligations to help others. In regard toHIV/AIDS patients, consequently, individualshave no duty to help, nor any other obligationbeyond that of respecting their rights; andthere is no valid basis for governmentregulations or subsidies on their behalf.The paper argues against the two approachescommonly used to defend a more expansive viewof individual obligations and the role ofgovernment. The first is the assumption ofwelfare rights to goods and services; thesecond is the assumption that distributivejustice requires some redistribution of healthcare resources.     

公共管理视野中的医患关系紧张

医惠关系是一种维持社会稳定的重要社会关系,近些年逐渐趋于紧张.一些学者对此进行了广泛地研究,但所提出的政策建议并没有使紧张的医惠关系得到缓解.为此,笔者从公共管理的角度,对医惠关系的界定,医患关系紧张的表现、原因进行了探讨,并提出了一些与其他学者不同的建议.     

Involving Local Health Departments in Community Health Partnerships: Evaluation Results from the Partnership for the Public’s Health Initiative

Improving community health “from the ground up” entails a comprehensive ecological approach, deep involvement of community-based entities, and addressing social determinants of population health status. Although the Centers for Disease Control and Prevention, the Office of the Surgeon General, and other authorities have called for public health to be an “inter-sector” enterprise, few models have surfaced that feature local health departments as a key part of the collaborative model for effecting community-level change. This paper presents evaluation findings and lessons learned from the Partnership for the Public’s Health (PPH), a comprehensive community initiative that featured a central role for local health departments with their community partners. Funded by The California Endowment, PPH provided technical and financial resources to 39 community partnerships in 14 local health department jurisdictions in California to promote community and health department capacity building and community-level policy and systems change designed to produce long-term improvements in population health. The evaluation used multiple data sources to create progress ratings for each partnership in five goal areas related to capacity building, community health improvement programs, and policy and systems change. Overall results were generally positive; in particular, of the 37 partnerships funded continuously throughout the 5 years of the initiative, between 25% and 40% were able to make a high level of progress in each of the Initiative’s five goal areas. Factors associated with partnership success were also identified by local evaluators. These results showed that health departments able to work effectively with community groups had strong, committed leaders who used creative financing mechanisms, inclusive planning processes, organizational changes, and open communication to promote collaboration with the communities they served. Cheadle is with the Department of Health Services, University of Washington, Seattle, WA, USA; Hsu, Pearson, and Beery are with the Center for Community Health and Evaluation, Seattle, WA, USA; Schwartz is with the Kaiser Foundation Health Plan and Hospitals, Oakland, CA, USA; Greenwald is with the School of Policy, Planning, and Development, University of Southern California, Los Angeles, CA, USA; Flores is with the The California Endowment, San Francisco, CA, USA; Casey is with the Partnership for the Public’s Health, Oakland, CA, USA.     

基于医患双方认知的公立医院公益性淡化原因及强化措施调查分析

在文献研究的基础上,对三种类型医院中的医护人员及患者进行关于公立医院公益性实现现状等问卷调查研究,探讨分析影响我国公立医院公益性淡化的主要原因,从而为促进我国公立医院公益性的回归、提高卫生服务的公平及可及性提供决策依据。     

Capacity in Thai Public Hospitals and the Production of Care for Poor and Nonpoor Patients

Objective. To assess the capacity of Thai public hospitals to proportionately expand services to both the poor and the nonpoor. This is accomplished by measuring the production of services provided to poor, relative to nonpoor, patients and the plant capacity of individual public hospitals to care for the patient load.
Study Setting. Thai public hospitals operating in 1999, following the economic crisis when public hospitals were required to treat all patients irrespective of ability to pay.
Study Design and Data Collection. Input and output data for 68 hospitals were collected using databases and questionnaire surveys. A distinction was made between inpatient and outpatient services to both poor and nonpoor patients and the data were assessed statistically.
Data Analysis. Congestion and capacity indices to measure poor/nonpoor service trade-offs and capacity utilization were estimated. The analysis was undertaken by data envelopment analysis (DEA), a nonparametric linear programming approach used to derive efficiency and productivity estimates.
Principal Findings. Increases in the amount of services provided to poor patients did not reduce the amount of services to nonpoor patients. Overall, hospitals are producing services relatively close to their capacity given fixed inputs. Possible increases in capacity utilization amounted to 5 percent of capacity.
Conclusions. Results suggest that some increased public hospital care can be accomplished by reallocation of resources to less highly utilized hospitals, given the budgetary constraints. However, further expansion and increase in access to health services will require plant investments. The study illustrates how DEA methodologies can be used in planning health services in data constrained settings.