社会医疗保险制度下公立医院财政补助机制

我国医疗卫生体制已从公共融合向公共契约模式转变，社会医疗保险的迅速推进使基本医疗需方投入为主成为实际的政策选择。在社会医疗保险制度框架下，公立医院仍有部分支出不能由社会医疗保险支付，需要财政补助予以保障。政府财政补助应与公立医院绩效评估机制相联系，以对公立医院经营者形成有效的激励约束机制。     

政府承担公共卫生职能的目标定位和范畴界定

针对政府公共卫生的管理职能和方式等两个问题，对政府承担公共卫生职能的目标定位和政府强化公共卫生管理职能进行了研究，提出了政府应保障民众最基本的医疗需求和公共卫生，进而提出政府应强化对公共卫生的筹资和分配，落实公共卫生体系建设和发展5项重点干预的建议。     

Human rights,transitional justice,public health and social reconstruction

Mass violence, armed conflict, genocide, and complex humanitarian emergencies continue to create major social and public health disasters at the dawn of the 21st Century. Transitional justice, a set of policies designed to address the effects of war on traumatized communities and bring justice, lies at the nexus of public health, conflict, and social reconstruction. Despite the paucity of empirical evidence, advocates of transitional justice have claimed that it can alleviate the effects of trauma, deter future violence, and bring about social reconstruction in war-affected communities. Empirical evidence – including new data and analyses presented in this article – suggests a link between trauma, mental health and attitudes towards and responses to transitional justice programs, but there has been little theoretical discussion about the intersection between public health and transitional justice, and even less empirical research to generate discussion between these two fields. Yet, public health professionals have an important role to play in assessing the impact of transitional justice on communities affected by mass violence. In this paper, we offer a conceptual model for future research that seeks to examine the relationship between transitional justice programs and their potential value to the fields of medicine and public health and discuss the methodological issues and challenges to a comprehensive evaluation of this relationship. To illustrate the discussion, we examine new data and analyses from two cases of contemporary conflicts, eastern Democratic Republic of Congo (DRC) and northern Uganda.     

我国公共卫生服务均等化的实证研究：重庆市公共卫生服务券的分析与评价

发放公共卫生服务券是公共卫生服务制度的一种创新,是实现公共卫生服务均等化的手段之一。由原来投入供方的机制,转变为投向需方,确保居民获得基本公共卫生服务机会的公平性和可及性, 促进卫生机构之间的公平竞争。通过现场考察和座谈,本文总结了重庆市公共卫生服务券制度的现状,分析了制度的优点和存在的问题。作者认为对该项制度需要进行长期的实践和对比评价,有很多理论问题值得进一步探讨。     

Use of social and behavioral sciences by public health departments in major cities

Individual behavior and social contexts are critical determinants of health. We surveyed commissioners or their designees in 22 departments of health serving US cities of at least 500,000 people to examine their use of scientific approaches to influence individual behavior and social contexts. Each department used behavioral or social science in its work, but only four departments were indged to have integrated these approaches throughout their operations, using both centralized and decentralized structures. Degree of integration was unrelated to collaboration with universities or communities but was related to use of explicit theories. Behavioral and social sciences were employed most frequently in the areas of HIV/AIDS and maternal and child health and in the service of changing individual behavior rather than larger contexts, although across departments many health problems and approaches were involved. Commissioners generally found the approaches valuable, but articulated barriers to more widespread adoption.     

A public health model of the social determinants of health

Summary As we move forward in the new century, epidemiologists and public health practitioners are faced with the challenge of reviewing the current direction of epidemiology and its links with public health. While the history of epidemiology has been a successful and productive one, there is a danger that modern epidemiology is becoming too narrow in its scope, concerned primarily with the analysis of risk factors in individuals, while ignoring sociological and ecological perspectives of health. We argue that a theoretical framework to guide the practice of epidemiology is needed which encompasses a role for social determinants of health while simultaneously also acknowledging the importance of behaviour and biology, and the inter-connectedness of all these factors. This paper presents a public health model of social determinants of health, which provides a framework for testing the causal pathways linking social determinant variables with health care system attributes, disease inducing behaviours and health outcomes. This approach provides an improved opportunity to identify and evaluate evidence-based public health interventions, and facilitates stronger links between modern epidemiology and public health practice.     

Canada: a land of missed opportunity for addressing the social determinants of health

The first 25 years of universal public health insurance in Canada saw major reductions in income-related health inequalities related to conditions most amenable to medical treatment. While equity issues related to health care coverage and access remain important, the social determinants of health (SDH) represent the next frontier for reducing health inequalities, a point reinforced by the work of the World Health Organization's Commission on Social Determinants of Health. In this regard, Canada's recent performance suggests a bleak prognosis. Canada's track record since the 1980s in five respects related to social determinants of health: (a) the overall redistributive impact of tax and transfer policies; (b) reduction of family and child poverty; (c) housing policy; (d) early childhood education and care; and (e) urban/metropolitan health policy have reduced Canada's capacity to reduce existing health inequalities. Reasons for this are explored and means of advancing this agenda are outlined.     

公立医疗机构公益性评价工具的研究与实践

阐述了公立医疗机构公益性评价工具的重要意义,介绍了公益性评价工具的形成过程与方法,论述了公益性评价工具的评价角度、结构组成、指标选取原则与实施步骤,为建立以公益性为核心的公立医疗机构绩效评价体系提供了坚实的理论基础。     

Hyalohyphomycosis and phaeohyphomycosis: Two global disease entities of public health importance

Two relatively new opportunistic diseases — hyalohyphomycosis and phaeohyphomycosis — are the byproduct, in most cases, of the progress being made in combating microbial and non-microbial diseases. Immunologically impaired hosts have become vulnerable to infection by fungi that were long considered to be innocuous. The currently known etiologic agents of these two diseases are listed and pertinent literature references are cited. The basic histologic differences between phaeohyphomycosis and chromoblastomycosis was emphasized and illustrated.     

公共卫生政府间责任与预算管理改革探讨

在公共卫生的政府间责任分担上,存在着理论划分与预算管理制度相分离的问题。预算改革迟滞是发生这一分离的根源,这一分离不仅导致政府间责任不能落实,并且误导人们陷入理论争论而缺乏对实践操作所需现实条件的关注。要实现两者的衔接,须进一步归类公共卫生服务,针对公共卫生的不同功能实行不同预算管理,将理论划分转换成预算科目,保障公共卫生政府间投入责任。     

公共卫生和公共卫生突发事件

该文从理论角度阐述什么是现代公共卫生观念 ,公共卫生应在公共卫生突发事件处理中发挥什么作用和怎样发挥作用 ,希望对确定我国现代公共卫生理论体系有所启发     

Critical appraisal for public health: a new checklist

OBJECTIVES: There have been a number of attempts to develop critical appraisal tools, but few have had a public health focus. This paper describes a new checklist with public health aspects. STUDY DESIGN: Review of previous appraisal instruments and pilot test of new checklist. METHODS: Criteria of particular reference to public health practice were added to well-established appraisal criteria. The checklist was piloted with 21 public health professionals, research staff or postgraduate students. RESULTS: The checklist is organized using the 'ask', 'collect', 'understand' and 'use' categories of the Population Health Evidence Cycle. Readers are asked to assess validity, completeness and transferability of the data as they relate to: the study question; key aspects of the methodology; possible public health implications of the key results; and the implications for implementation in their own public health practice. Of the 21 public health professionals that piloted the checklist, 20 said that they found the checklist useful and 18 would use it or recommend it in the future. Participants were prepared to commit to the majority of the questions, and there was good agreement with a consensus of 'correct' answers. CONCLUSIONS: The public health critical appraisal checklist adds public health aspects that were missing from previous critical appraisal tools.     

New questions,new data,old interventions: The health effects of a guaranteed annual income

Objectives

This study investigates whether administration data from universal health insurance can yield new insight from an old intervention. Specifically, did a guaranteed annual income experiment from the 1970s, designed to investigate labor market outcomes, reduce hospitalization rates?

Method

The study re-examined the saturation site of a guaranteed annual income experiment in Dauphin, Manitoba (CANADA) conducted between 1974 and 1979 (MINCOME). We used health administration data generated by the universal government health insurance plan to identify subjects (approximately 12,500 residents of Dauphin and its rural municipality). We used propensity-score matching to select 3 controls for each subject from this database, matched on geography of residence, age, sex, family size and type. Outcome measures were hospital separations and physician claims.

Results

Hospital separations declined 8.5% among subjects relative to controls during the experimental period. Accident and injury codes and mental health codes were most responsible for the decline.

Conclusions

Even though MINCOME was designed to measure the impact of a GAI on the number of hours worked, one can re-visit old experiments with new data to determine the health impact of population interventions designed for other purposes. We determined that hospitalization rates declined significantly after the introduction of a guaranteed income.     

New competencies for public health graduates: a useful tool for course design

Objective: The objective of this paper is to provide a brief overview and context for the new Australian Network of Public Health Institutions (ANAPHI) Foundation Competencies for Master of Public Health Graduates in Australia, and to outline the current status of the quality agenda for public health training and competency standards for Master of Public Health (MPH) education in Australia. Approach: We summarise the complex history and process of developing competency standards for Master of Public Health courses in Australia, including the logic for a competency‐based set of training guidelines. An abridged example of a competency and its underpinning knowledge is provided. Conclusions and implications: This set of competency standards will be useful for MPH course designers, and critical to maintaining the standard of MPH courses in the current (and changing) health policy context, both in Australia and internationally.     

Beyond procedural ethics: Foregrounding questions of justice in global health research ethics training for students

Interest in global health is growing among students across many disciplines and fields of study. In response, an increasing number of academic programmes integrate and promote opportunities for international research, service or clinical placements. These activities raise a range of ethical issues and are associated with important training needs for those who participate. In this paper, we focus on research fieldwork conducted in lower income nations by students from more affluent countries and the ethics preparation they would benefit from receiving prior to embarking on these projects. Global health research is closely associated with questions of justice and equity that extend beyond concerns of procedural ethics. Research takes place in and is shaped by matrices of political, social and cultural contexts and concerns. These realities warrant analysis and discussion during research ethics training. Training activities present an opportunity to encourage students to link global health research to questions of global justice, account for issues of justice in planning their own research, and prepare for ‘ethics-in-practice’ issues when conducting research in contexts of widespread inequality. Sustained engagement with questions of justice and equity during research ethics training will help support students for involvement in global health research.     

Promoting social responsibility for health: health impact assessment and healthy public policy at the community level

The 1997 Jakarta Declaration on Health Promotion into the 21st Century called for new responses to address the emerging threats to health. The declaration placed a high priority on promoting social responsibility for health, and it identified equity-focused health impact assessment as a high priority for action. This theme was among the foci at the 2000 Fifth Global Conference on Health Promotion held in Mexico. This paper, which is an abbreviation of a technical report prepared for the Mexico conference, advances arguments for focusing on health impact assessment at the local level. Health impact assessment identifies negative health impacts that call for policy responses, and identifies and encourages practices and policies that promote health. Health impact assessment may be highly technical and require sophisticated technology and expertise. But it can also be a simple, highly practical process, accessible to ordinary people, and one that helps a community come to grips with local circumstances that need changing for better health. To illustrate the possibilities, this paper presents a case study, the People Assessing Their Health (PATH) project from Eastern Nova Scotia, Canada. It places ordinary citizens, rather than community elites, at the very heart of local decision-making. Evidence from PATH demonstrates that low technology health impact assessment, done by and for local people, can shift thinking beyond the illness problems of individuals. It can bring into consideration, instead, how programmes and policies support or weaken community health, and illuminate a community's capacity to improve local circumstances for better health. This stands in contrast to evidence that highly technological approaches to community-level health impact assessment can be self-defeating. Further development of simple, people-centred, low technology approaches to health impact assessment at the local level is called for.     

国内公共卫生服务均等化的理论探讨及研究现状

公共卫生服务均等化是当前社会经济生活中的热点,也是新医改方案明确提出的今后三年的五项重点工作之一。本文主要从对公共服务均等化时代内涵的理解入手,分析和总结我国公共卫生服务均等化的现状、存在的问题及公共财政体制对均等化的影响,认为实现公共卫生服务均等化,政府公共财政需承担更大的责任,同时要加快公共财政立法保证均等化的实现。     

Integrating human health into environmental impact assessment: an unrealized opportunity for environmental health and justice

OBJECTIVES: The National Environmental Policy Act and related state laws require many public agencies to analyze and disclose potentially significant environmental effects of agency actions, including effects on human health. In this paper we review the purpose and procedures of environmental impact assessment (EIA), existing regulatory requirements for health effects analysis, and potential barriers to and opportunities for improving integration of human health concerns within the EIA process. DATA SOURCES: We use statutes, regulations, guidelines, court opinions, and empirical research on EIA along with recent case examples of integrated health impact assessment (HIA)/EIA at both the state and federal level. DATA SYNTHESIS: We extract lessons and recommendations for integrated HIA/EIA practice from both existing practices as well as case studies. CONCLUSIONS: The case studies demonstrate the adequacy, scope, and power of existing statutory requirements for health analysis within EIA. The following support the success of integrated HIA/EIA: a proponent recognizing EIA as an available regulatory strategy for public health; the openness of the agency conducting the EIA; involvement of public health institutions; and complementary objectives among community stakeholders and health practitioners. We recommend greater collaboration among institutions responsible for EIA, public health institutions, and affected stakeholders along with guidance, resources, and training for integrated HIA/EIA practice.     

Anticipating crisis: towards a pandemic flu vaccination strategy through alignment of public health and industrial policy

Flu pandemics (worldwide epidemics) have occurred at irregular and unpredictable intervals, and have been associated with substantial morbidity, mortality and economic cost. In response to the emerging potential for a new pandemic to occur, national and international preparedness plans are being drawn up specifying the use of antivirals and vaccines. A number of challenges to pandemic vaccine development, large-scale production and the timing of distribution have also been highlighted. This article reviews the rationale and consequential policy for aligned public- and private sector planning in the present inter-pandemic period despite the prevalent risks and uncertainties. We propose a model for product development of pandemic flu vaccine based on public–private partnership, including push and pull incentive mechanisms for stimulating work in this therapeutic area. In addition, we argue that innovative vaccination strategies, together with special vaccine formulations which may offer cross-protection against multiple flu pandemic strains might avert the worse effects of an influenza infection.