Healthcare regulation as a tool for public accountability

The increasing costs of healthcare delivery led to different political and administrative approaches trying to preserve the core values of the welfare state. This approach has well documented weaknesses namely with regard to healthcare rationing. The objective of this paper is to evaluate if independent healthcare regulation is an important tool with regard to the construction of fair processes for setting limits to healthcare. Methodologically the authors depart from Norman Daniels’ and James Sabin’s theory of accountability for reasonableness and try to determine if new regulatory models—namely independent agencies—perform better with regard to the public disclosure of the reasons and rationales of healthcare rationing. In publicly financed healthcare systems independent regulation is an important tool to assure fair and reasonable procedures of prioritising services. In accordance with the principle of public accountability, independent regulatory agencies are particularly well suited to assure publicity of the decision-making processes, relevance of the rationale involved and particularly mechanisms for challenge and dispute resolution regarding limit setting decisions. It follows that independent healthcare regulation could be regarded not only as an instrument for performance improvement but also as a tool of social justice. The authors conclude by stating that accountability for reasonableness should be regarded as a landmark of any healthcare reform. And therefore regulators have the social task of assuring that the rationales for limit-setting decisions are clearly accessible to the public.     

卫生保健领域中社会资本指标探讨

社会资本是促进人群健康和卫生行业发展的重要动力。结合我国医疗卫生国情剖析社会资本理论中信任、群众参与、社会网络、规范、互惠、能动性等指标的内涵,及其对人群健康、卫生机构乃至卫生保健全行业发展的影响,为开发和利用社会资本发展卫生事业、增进人群健康提供理论依据。     

卫生保健领域中社会资本指标探讨

社会资本是促进人群健康和卫生行业发展的重要动力.结合我国医疗卫生国情剖析社会资本理论中信任、群众参与、社会网络、规范、互惠、能动性等指标的内涵,及其对人群健康、卫生机构乃至卫生保健全行业发展的影响,为开发和利用社会资本发展卫生事业、增进人群健康提供理论依据.     

卫生领域中政府管制作用的探讨

目的:探讨卫生领域中政府的管制作用。方法:通过文献复习进行理论探讨。结果:当前,我国卫生系统正面临着严重的信任危机。问题的根源是制度的缺陷,政府治理和监管的不足是关键。卫生系统改革中存在的诸多问题需要通过发挥政府的主导作用和充分利用市场的竞争机制来解决。医生的职业道德、伦理观、诚信及对患者的尊重和反应性在医患关系中处于主导的地位。对政府管制的认识应该是“管办分离,政事分开,分类管理”。政府部门将从“办卫生”转变为综合运用经济、法律和行政等手段来“管卫生”。卫生政策的制定要“以人为本”,要有及时性。结论:我国卫生改革成功的标志应该是:(1)要达到卫生服务的可及性和可承受性。解决和缓解“看病难、看病贵”问题;(2)要有公正的卫生筹资机制,建立全民的医疗保障制度是今后努力的方向;(3)具有良好的健康状况(4)要有一个创新的卫生体制和机制。     

Regulatory Effects in Health Care

Abstract

In spite of the fact that other service sectors such as airlines, retail banking, telecommunications, railroads, trucking, securities brokerage, and insurance have experienced remarkable transformations toward more deregulated environments, the health care industry continues to be very heavily regulated. This article first examines the major theories and general schools of thought surrounding the concept of regulation in general, followed by an examination of the influence governmental regulations have had on hospitals in particular, specifically as they relate to stimulating competitiveness, efficiencies, and cost control.     

社会健康保险费用上涨及其成因的定量分析

本文运用定量分析的方法对我国社会健康保险费用不断上涨的现象，从控制上涨的特点、费用增长的四个因素入手，研究了从１９５２年到１９８９年这一时期社会健康保险的享受人数、通货膨胀对其影响、年龄老化及疾病谱的改变等几个对社会健康保险费用上涨具有重大影响的问题。从中得出了综合性的分析结果，并进一步提出了费用增长的不可避免性，以及在干预因素上多作文章的结论。     

Power,Technology and Social Studies of Health Care: An Infrastructural Inversion

Power, dominance, and hierarchy are prevalent analytical terms in social studies of health care. Power is often seen as residing in medical structures, institutions, discourses, or ideologies. While studies of medical power often draw on Michel Foucault, this understanding is quite different from his proposal to study in detail the “strategies, the networks, the mechanisms, all those techniques by which a decision is accepted” [Foucault, M. (1988). In Politics, philosophy, culture: Interviews and other writings 1977–84 (pp. 96–109). New York: Routledge]. This suggestion turns power into a topic worth investigating in its own right rather than a basic analytical resource. It also suggests that technologies form an integral part of the networks and mechanisms, which produce and redistribute power in medical practice. The paper first engages critically with a number of recent discussions of technology and power in health care analysis. It then formulates an alternative conception of this relationship by drawing on Foucault and historian of science and technology Geoffrey C. Bowker’s notions of infrastructural inversion and information mythology. Illustration is provided through a case study of a wireless nursing call system in a Canadian hospital.

古巴医疗体制发展历程及其启示

财富-健康的因果关系——这个曾经被人们普遍接受的观点现在受到了挑战。古巴作为中低收入国家,其国民健康状况却达到了发达国家的水平。介绍了古巴医疗体制建立与发展的不同阶段,从历史角度理解古巴医疗体制的概貌;同时勾勒了医疗配送和医疗融资体系,从医疗供给与需求的角度描述了古巴的公立医疗体制;最后从古巴的成功医疗体制经验中提出了医疗公平性对发展中国家的重要性、市场手段未必能够保证效率、基础医疗是成功医疗体制的基石,以及医疗供求市场的统一与分离的重新思考等4点对中国的有益启示。     

医疗体系中外展社区服务的重要性

院外医护服务在香港医疗体系中起着重要作用。院外医护医疗工作者如社区护士、家庭服务志愿者和社会工作者来自于社区的助人网络。 院外医护人员的优点是: (1)延长医护服务的连续性;(2)缓解病人的心理压力;(2)监察病情;(4)推广健康教育知识。     

健康医疗大数据质量治理研究

健康医疗大数据质量治理对促进医疗大数据产出具有重要的研究价值。通过分析健康医疗大数据特点,指出医疗大数据存在的质量问题,提出质量治理的对策建议,包括全面加强质量管理组织机构与人才队伍建设,加快数据质量标准体系建设,积极推动数据质量管理工具等关键技术的发展,落实医疗机构内部数据质量安全管理规范等。     

糖尿病病人的保健意识调查

目的 研究糖尿病人对糖尿病保健知识的了解程度。方法 用访谈法调查了243例2型糖尿病人保健意识。结果 糖尿病人的保健知识的来源主要是印刷宣传品,占51．1％;其次是医护人员,占38．2％。不同年龄的糖尿病患者对运动和并发症方面的保健知识的了解程度有所不同,不同文化程度的糖尿病患者对戒烟酒、血糖尿糖自测和并发症方面的保健知识的了解程度有所不同。结论 应该有针对性地加强有关糖尿病保健知识的健康教育。     

浅谈老年人的旅行卫生保健

随着人民生活水平的不断提高，旅游业的逢勃发展，老年人旅行也不断增多。如何保障老年人旅行的健康，是一个十分重要的课题。针对老年人群旅行的特殊性，为避免在旅行中可能受到某种危害因素的影响，提出旅行前要做好以下准备工作：第一，健康检查，做一些必要的检查，根据老年人提供的资料及检查结果，评估旅行者心理健康和身体健康状况，确定是否适宜旅行；第二，旅行卫生保健咨询，为旅行者提供卫生保健知识，进行旅行卫生指导；第三，旅行有关的信息收集；第四，向旅行者提出要注意的事项。在旅行时还必须有保健医生随团，确保老年旅行者有一个安全愉快的旅程。     

High-Tech Home Health Care

This study examines staff perspectives and personnel issues related to the delivery of high-tech home health care services to older adults. Data were collected from a national sample of 154 agency directors and 92 local agency staff. Agency staff and directors consistently report an increase in high-tech service delivery over the past five years. Both agency directors and local staff agree that a variety of staff may be involved in the delivery of high-tech services, including both professional and paraprofessional staff. Although agency directors report providing training to at least one or more type of direct care staff, agency staff are less likely to report being required to participate in training programs. The provision of high-tech services impacts the agency, the staff, and the patient in various ways. Most staff feel that high-tech care enhances the quality of life of older patients, although high-tech care may be somewhat difficult to define and even more difficult to deliver. Challenges related to the provision of high-tech care, including providing adequate staff training, and developing appropriate quality assurance measures, are discussed.     

亚健康与保健

本文采用文献综述和临床观察等方法,对亚健康的概念及其表现特征进行描述与阐释,探讨亚健康的起因,并结合中医经络学和治未病理论以及本人亲身体验,提出了干预亚健康的10种简便易行的保健方式与方法,旨在对人们进一步认识亚健康、预防亚健康有所裨益。     

健康教育在儿童保健门诊的应用

目的通过健康教育,让家长掌握正确的喂养、护理、预防疾病等知识,以促进儿童健康成长。方法将儿童从出生到学龄前期的健康教育,纳入到常规的儿童保健工作内容中,分别在门诊、家庭、托幼园所对儿童不同时期进行相应的健康教育。结果通过各种形式的健康教育,普及了儿童保健知识,对儿童常见病、多发病的检测起到了早发现、早治疗的作用,同时建立了良好的医患关系,提高了医院的经济效益。结论健康教育的系统干预,是促进儿童保健实施的关键,可以改善儿童及其家长的健康行为。     

浅谈健康教育在居家临终关怀中的应用

癌症患者的直系亲属是健康教育的重点人群。癌症防控前移,除了大众化的健康促进外,在居家临终关怀中充分利用健康教育的优势,针对性强,接受程度高,特别是看着亲人受病痛折磨时候或离去时,在万般无奈及悲痛的同时,对生命的价值理解更深更透,珍惜生命,承担起家庭、社会的责任感更强,此时开展以病因预防为主的健康教育是最佳时间。切实抓紧抓好,必将产生深远影响。     

首次福建省托幼机构卫生保健情况调查分析

为了了解福建省托幼园所卫生保健工作情况，加强保健工作规范化管理，并为改进保健举措提供科学根据。「方法」制定福建省托幼园所卫生保健报表，并应用该表对托幼机构卫生保健进行首次分析。结论福建省各托幼机构卫生保健已初具规模，尚需加强保健人员配备和培训及幼儿五官保健，疾病管理和矫治。