立体式全方位推进政府购买卫生服务方式

政府购买卫生服务是卫生服务提供方式的重大变革,各级政府对此应进行积极有益的探索.在新医改形势下,全立体式全方位推进政府购买卫生服务方式具有极其重要的战略意义.     

上海市嘉定区政府购买社会组织精神卫生服务的实践探索

近年来,随着政府购买服务发展社会公共事业的不断推进,引进社会组织补充服务日渐成为当代公共服务的重要机制。上海嘉定区政府购买精神卫生服务经过5年的探索与实践,逐步摸索出一套系统、完善的项目化工作流程机制。政府购买精神卫生服务,不仅突破精神卫生服务资源严重不足的困境,也是提供专业、多元精神健康服务的绩优选择。但在实际运行过程中,也发现一些问题,如绩效考核评价机制有待完善、社会组织自我发展能力有待提高、监管机制有待加强等。     

英国“购买与提供分开”下的健康服务整合改革及启示

以人为本的整合型卫生服务体系是当前国际卫生体系发展的重要方向。鉴于英国卫生体系综合绩效在发达国家中的领先地位,在\"购买与提供分开\"的框架下政府同时负责筹资和服务组织的结构,这与我国卫生体系具有相似性,本文根据文献研究和现场调查,分析英国近年建设以人为本整合型卫生服务体系的内在逻辑和实践进展,并探讨其对我国的启示。研究发现,改革主要体现在三个层面：区域层面推动卫生部门内部各机构与跨部门服务的统一规划,并辅以转型基金、绩效考核和整合式的预算分配与决策机制;地方层面以公共卫生和医疗服务的筹资整合推动服务围绕人群健康进行协调,应对人群层面的健康问题;社区层面通过对全科医生执业模式进行再组织,在基层卫生网络基础上结合社区服务,综合应对个体和社区层面的健康决定因素。根据英国经验,本文提出：整合改革涉及多个层面,应当明确各自权责;统一的决策问责、协调的资源分配是推动整合的关键抓手;基层卫生发展需要在专业化基础上进行组织化。     

政府购买卫生服务研究现状评述和研究角度建议

当前,对政府购买卫生服务的研究,已经取得了阶段性的成果,但在研究的深度、广度上仍有进一步拓展的空间。在新＂医改＂的形势下,为了配合政府购买卫生服务的政策实践,需要深入开展政府购买卫生服务的理论研究。     

广西政府购买社区卫生服务政策试点效果评析

政府购买是卫生服务提供方式的重大变革。广西政府购买社区卫生服务政策试点现核心问题一是试点工作的点的数量不足;二是试点工作的试的深度不够;三是试点进行的前奏条件、关键环节、后续保障机制没有建立健全。建议政府购买社区公共卫生服务的局部试点与全局推广必须构建一体两翼的推行模式。     

我国政府购买公共卫生服务的实践和特点

目的 总结我国政府购买公共卫生服务的实践经验,为其进一步完善和推广提供经验支持.方法 采用文献综述法,从电子和公开出版物两个来源获取相关文献,根据研究类型和研究主题筛选纳入相关文献.结果 服务提供者类型包括公立和私立的医疗机构,其运行机制由筹资、服务项目选择、监督和评价以及支付等环节组成,对公共卫生服务的可及性和质量产生了积极作用.但是对公共卫生服务效率和公平的影响还不确定.结论 我国政府购买公共卫生服务改革推广对改善居民公共卫生服务的利用起到了推动作用.     

政府购买服务的理论探究

中央有关农村卫生工作的政策文件中 ,对于在市场经济体制条件下的政府职能 ,有了新的规定。首先 ,政府对公共卫生负有一定责任 ,在提供公共卫生服务的形式上 ,一改过去单一的方式 ,采取了多种方式。其次 ,在提供方式上 ,既可以由政府直接提供 ,即由政府直接办公共卫生的服务机构 ,包括预防保健机构等 ,也包括现今有的地方在乡卫生院产权变革后 ,政府办的防保所等形式 ,也可以由政府通过购买服务的形式来体现政府应承担的责任。前者的形式是传统的做法 ,卫生部门很容易认同并接受 ,而对后一种形式 ,不理解的有之 ,不认同也有之 ,甚至还有反对…     

政府购买公共服务在卫生服务领域的可行性探讨

政府购买公共服务的方式既体现了政府应承担的责任,又适应了市场经济发展的规律,有利于社会公共服务体系的可持续性发展.自十一五期间,政府购买公共服务已经成为我国部分地区(上海、北京等)公共服务体制改革的主要思路之一.通过系统阐述政府购买公共服务的基本概念、理论依据以及试点情况,探索卫生服务领域开展政府购买的理论依据.     

广西政府购买社区公共卫生服务的调查报告——柳州市政府购买服务的启示

政府购买社区公共卫生服务是政府社区卫生服务提供方式的重大变革.广西政府购买社区卫生服务政策试点过程中的问题主要表现在试点工作的"点"数量不足;试点工作的"试"深度不够;试点进行的实施条件与后续保障机制准备不足.政府购买社区公共卫生服务的局部试点与全局推广必须在扩宽试点数量、拓深试点深度的基础上构建"一体两翼"的推行模式.     

欧洲国家卫生服务购买模式的经验与启示

在世界卫生组织提出将卫生服务战略性购买作为主要的改革策略之后,欧洲一些国家开始进行了比较系统的实践,取得了一些经验,但是,也还存在一些有待完善的地方。由此,该文系统地介绍了欧洲一些国家在这方面的实践经验与改革探索,并提出了相关的政策建议。     

Ownership, control, and contention: challenges for the future of healthcare in Malaysia

The recent history of healthcare privatisation and corporatisation in Malaysia, an upper middle-income developing country, highlights the complicit role of the state in the rise of corporate healthcare. Following upon the country's privatisation policy in the 1980s, private capital made significant inroads into the healthcare provider sector. This paper explores the various ownership interests in healthcare provision: statist capital, rentier capital, and transnational capital, as well as the contending social and political forces that lie behind state interests in the privatisation of healthcare, the growing prominence of transnational activities in healthcare, and the regional integration of capital in the healthcare provider industry. Civil society organizations provide a small but important countervailing force in the contention over the future of healthcare in the country. It is envisaged that the healthcare financing system will move towards a social insurance model, in which the state has an important regulating role. The important question, therefore, is whether the Malaysian government, with its vested interests, will have the capacity and the will to play this role in a social insurance system. The issues of ownership and control have important implications for governance more generally in a future healthcare system.     

Professional projects and institutional change in healthcare: the case of American dentistry

This paper combines resources from the organization studies and sociology literatures to advance understanding of institutional change processes in healthcare that emerge from the professionalization projects of occupations. Conceptually, we introduce a model that combines the 'archetype' approach to analyzing structural change with a framework for analyzing the agency of emergent professions. We then employ the model to frame a historical case analysis (1972-2009) of the highly contested process by which the occupation of dental hygiene in the US fought to introduce a new organizational form, the alternative practice hygiene (APH) archetype. This archetype challenges the traditional model (the dentist's office archetype) that is supported by the dominant dentistry profession. Our analysis contributes two main sets of empirical findings. First, we present a systematic comparison of the APH and Dentist's Office archetypes in terms of their belief systems, formal structures, agents, and policy implications (e.g., access to services). Second, we provide an account of the agency of dental hygienists' attempts to secure the APH model as part of their professionalization project.     

Impact of multi-morbidity on quality of healthcare and its implications for health policy,research and clinical practice. A scoping review

Abstract

The simultaneous presence of multiple conditions in one patient (multi-morbidity) is a key challenge facing healthcare systems globally. It potentially threatens the coordination, continuity and safety of care. In this paper, we report the results of a scoping review examining the impact of multi-morbidity on the quality of healthcare. We used its results as a basis for a discussion of the challenges that research in this area is currently facing. In addition, we discuss its implications for health policy and clinical practice. The review identified 37 studies focussing on multi-morbidity but using conceptually different approaches. Studies focusing on ‘comorbidity’ (i.e. the ‘index disease’ approach) suggested that quality may be enhanced in the presence of synergistic conditions, and impaired by antagonistic or neutral conditions. Studies on ‘multi-morbidity’ (i.e. multiplicity of problems) and ‘morbidity burden’ (i.e. the total severity of conditions) suggested that increasing number of conditions and severity may be associated with better quality of healthcare when measured by process or intermediate outcome indicators, but with worse quality when patient-centred measures are used. However, issues related to the conceptualization and measurement of multi-morbidity (inconsistent across studies) and of healthcare quality (restricted to evaluations for each separate condition without incorporating considerations about multi-morbidity itself and its implications for management) compromised the generalizability of these observations. Until these issues are addressed and robust evidence becomes available, clinicians should apply minimally invasive and patient-centred medicine when delivering care for clinically complex patients. Health systems should focus on enhancing primary care centred coordination and continuity of care.     

妇幼保健院产科医疗服务质量需求分析

目的:探讨妇幼保健院产科顾客对医疗服务质量的需求。方法:按照预先设计的调查问卷从2010年3月~2010年5月对广东省某妇幼保健院产科的顾客进行随机抽样调查并对结果进行分析。结果:顾客对妇幼保健院产科医疗服务质量的需求绝大部分均在80%以上,而对结构质量的医护人员技术水平、仪器设备能满足需要和医院在当地声誉及不出现医疗差错事故、危急情况能快速正确处理、医务人员有责任心、诊断准确及时、医务人员操作熟练且符合规范、有特殊情况随时与病人(家属)联系、医务人员医德、医风好、医务人员服务态度好、处理方案合理、医务人员尊重患者的知情权以及结果质量、服务满意和费用合理等需求均在90%以上。结论:产科顾客对妇幼保健院的医疗服务质量需求较高,医院应努力提高医疗服务质量,满足他们的需求。     

Effects of housing circumstances on health, quality of life and healthcare use for people with severe mental illness: a review

Individuals with severe and persistent mental illness (SPMI) identify housing as an important factor in achieving and maintaining their health. However, many live in substandard accommodations that are physically inadequate, crowded, noisy and located in undesirable neighbourhoods. In much of the research on housing for persons with SPMI, the central outcome of interest is remaining housed; however, it is worth investigating whether housing has other benefits. This paper is a systematic review of studies that investigated the relationship between housing-related independent variables and health-related dependent variables. Ten online databases were searched for studies published since 1980 that had study populations of adults with SPMI, analysed primary or secondary empirical data, and measured housing-related independent variables and health-related dependent variables. Clearly defined epidemiological criteria were used to assess the strength of evidence of the selected studies. Twenty-nine studies met the suitability criteria, of which 14 reported healthcare utilisation outcomes; 12 examined mental status outcomes; and 9 reported quality-of-life outcomes. The findings of the review suggest that there is good evidence that housing interventions benefit the homeless population; however more research is needed about housing solutions for individuals with SPMI who are housed, but in precarious or inappropriate housing situations. Study methodologies could be improved by emphasising longitudinal designs that focus on participant retention and by implementing matched control groups or randomised interventions to strengthen internal validity. Ensuring that a person is adequately housed upon discharge from hospital should be a treatment priority. When housing eligibility is not dependent on psychiatric treatment compliance and sobriety, providing permanent housing minimises harm and may free people to voluntarily seek treatment. Housing that offers an unlimited length of stay is recommended because SPMI is a chronic and fluctuating condition that requires stable surroundings to maintain health.     

中国老年人对医疗服务与长期照料服务的需要与利用研究——基于中国健康与养老追踪调查的实证分析

目的 了解中国老年人对医疗和长期照料服务的需要与利用情况;分析对医养结合型服务的潜在需要;为促进我国医养结合型服务的发展提供参考依据。方法 利用中国健康与养老追踪调查的数据,分析60岁以上老年人对医疗服务与长期照料服务的需要与利用情况以及对医养结合型服务的潜在需要。结果 全体老年人中,有14.01%和7.21%的老人存在应就诊而未就诊和应住院未住院的情况;在失能老人中,有39.44%的比例未获得照料;在潜在存在医养结合型服务需要的老人中,仅有37.46%的老人两种需要同时得到满足。结论 老年人对医疗与长期照料服务的需要较大并且同时存在,但对它们的利用并不充分。建议政府推进医养结合型服务的发展,在促进医养结合型服务供给的同时提高对老年人的保障力度。     

Content comparison of health-related quality of life measures used in stroke based on the international classification of functioning,disability and health (ICF): a systematic review

OBJECTIVE: To examine and compare the contents of health-related quality of life (HRQoL) measures used in stroke, based on the ICF as the frame of reference. DESIGN: We conducted a systematic literature review to select current generic and condition-specific HRQoL measures applied in stroke. We examined the contents of the selected measures by linking the concepts within the instruments' items to the ICF. RESULTS: The systematic literature review resulted in the selection of six generic and seven stroke-specific HRQoL measures. Within the selected instruments we identified 979 concepts. To map these concepts, we used 200 different ICF categories. None of the ICF categories is contained in all of the instruments. The most frequently used category is 'b152 Emotional functions' contained in 53 items from 10 instruments. Stroke-specific measures more often address 'Mental functions', while the selected generic instruments more often include Environmental Factors. DISCUSSION: The present study provides an overview on current HRQoL measures in stroke with respect to their covered contents and provides valuable information to facilitate the selection of appropriate instruments for specific purposes in clinical as well as research settings.     

Systematic review of reporting rates of adverse events following immunization: An international comparison of post-marketing surveillance programs with reference to China

Background

China is the most populous country in the world, with an annual birth cohort of approximately 16 million, requiring an average of 500 million vaccine doses administered annually. In China, over 30 domestic and less than 10 overseas vaccine manufacturers supply over 60 licensed vaccine products, representing a growing vaccine market mainly due to recent additions to the national immunization schedule, but data on post-marketing surveillance for adverse events following immunization (AEFI) are sparse.

Objectives

To compare reporting rates for various categories of AEFI from China with other routine post-marketing surveillance programs internationally.

Methods

Systematic review of published studies reporting rates of AEFI by vaccine, category of reaction and age from post-marketing surveillance systems in English and Chinese languages.

Results

Overall AEFI reporting rates (all vaccines, all ages) in Chinese studies were consistent with those from similar international studies elsewhere, but there was substantial heterogeneity in regional reporting rates in China (range 2.3–37.8/100,000 doses). The highest AEFI reporting rates were for diphtheria–tetanus–pertussis whole-cell (DTwP) and acellular (DTaP) vaccines (range 3.3–181.1/100,000 doses for DTwP; range 3.5–92.6/100,000 doses for DTaP), with higher median rates for DTwP than DTaP, and higher than expected rates for DTaP vaccine. Similar higher rates for DTwP and DTaP containing vaccines, and relatively lower rates for vaccines against hepatitis B virus, poliovirus, and Japanese encephalitis virus were found in China and elsewhere in the world.

Conclusions

Overall AEFI reporting rates in China were consistent with similar post-marketing surveillance systems in other countries. Sources of regional heterogeneity in AEFI reporting rates, and their relationships to differing vaccine manufacturers versus differing surveillance practices, require further exploration.