德国医疗保障体系改革及启示

德国是世界上最早建立社会医疗保障制度的国家,其医疗保障体系以法定医疗保险为主,私人医疗保险为辅,基本实现了全民覆盖。本文在梳理德国医疗保障体系三次改革的基础上,阐述德国当前医保管理模式、医疗保险体系、医疗服务体系以及对弱势人群进行保障的现状特点,归纳德国医疗保障体系在发挥市场机制、医保福利包设计、提供均等医疗服务、实行家庭医生制度、注重质量和效率的具体经验,进而提出厘清政府和市场的关系、适时调整医保福利包、逐步建立分级诊疗模式、保障公平的医疗服务以及合理控制医药费用等建议。     

我国医疗服务公益性导致"看病难、看病贵"

一直以来，我国的卫生事业被定性为政府实行一定福利政策的社会公益事业。笔者认为，公共卫生、医学科研、健康教育、医疗保障等的公益性质是毋庸置疑的，但医疗服务也应是公益性质吗？     

加拿大医疗保健本制面面观之一加拿大医疗体制的特点

加拿大向来以社会安定、福利优越而闻名，其中在众多的福利中，可能最让加拿大人引以为豪的是它的全民医疗保健体制。美国前总统克林顿上台伊始，就曾组织智囊机构对加拿大的医疗体制进行深入的研究，试图对美国现行私人医疗保险体制进行改革，并建立一个类似加拿大的全民医疗保障体系。虽然方案提了一个又一个，最终由于美加两国税收体制的根本不同而无法实行其全民免费医疗的设想。     

英国全民医疗服务体系的改革及启示

一、英国全民医疗服务体系（National Health Service System,NHS）简介英国是最早实行全民免费医疗保障的国家,早在《贝弗里奇报告》出台之后,英国就设计了＂从摇篮到坟墓＂的一整套福利政策。     

1085个乡镇企业医疗保险形式及其影响因素的分析

本文对１０８５个有医疗保障的乡镇企业，按其成立时间、地业、经济类型、企业规模、人均福利等指标。对其所采用的不同医疗保障不同医疗保障措施进行了分析。分析表明，军保医疗主要分布成成立时间较早的企业和乡办企业；合作医疗主要分布在非乡办企业和成立时间罗晚的企业，医疗保险主要分布在乐部和西部地区、三资企业及人均工资福利较高的企业。     

谈卫生事业单位管理与会计实时控制

我国的卫生事业是政府实行一定福利政策的非营利性公益事业，其范围涉及卫生服务、医疗保障、卫生执法监督、医学教育等领域，在国民经济和社会发展中具有独特的地位，发挥着不可替代的作用。作为卫生事业的主体——卫生事业单位，其管理的目标就是充分利用拥有的资源，高效率地提供卫生服务，满足人们日益增长的健康需求。     

不同医疗保障形式人群的就医行为调查

本文通过对1311名享有不同医疗保障形式就医者的调查结果分析，认为在医疗保障制度尚未改革的情况下，人们的医疗保障形式决定了他们就医时对医院的选择；大多数就医者对药物的认识存在着偏差，指名要药行为较为普遍。进而指出实行医疗保障制度改革的必要性和紧迫性，在改革过程中，要将治疗质量高、服务态度好的医院作为定点医院。     

加拿大医疗保健体制面面观之一 加拿大医疗体制的特点

加拿大向来以社会安定、福利优越而闻名,其中在众多的福利中,可能最让加拿大人引以为豪的是它的全民医疗保健体制。美国前总统克林顿上台伊始,就曾组织智囊机构对加拿大的医疗体制进行深入的研究,试图对美国现行私人医疗保险体制进行改革,并建立一个类似加拿大的全民医疗保障体系。虽然方案提了一个又一个,最终由于美加两国税收体制的根本不同而无法实行其全民免费医疗的设想。     

美军卫生经费现况及控制

本文研究美军平时医疗保障经费的来源、数量、用途、历史变化情况、费用控制措施,探讨美军卫生经费快速增长的主要原因以及医疗保障费用的未来发展趋势。近十几年来,美军卫生经费总额、人均费用及占国防费比例持续增长,主要原因包括:保障对象的个人付费水平显著低于地方水平;保障对象的医疗保障福利不断扩大和增长;军队医疗保障计划的使用率持续增长;急诊使用率较高;战争加剧卫生费用增长。近几年,美军卫生费用的增长幅度已开始下降,主要是在卫生费用控制方面采取的创新性措施,包括实行预期支付制度和慢性疾病管理等。     

关于我国城乡医疗保障体制构建实践总结与战略思考

随着我国市场经济的进一步发展、产业结构调整和社会结构急剧转型，城镇和农村居民的医疗保障问题日显突出，解决全民医疗保障的问题已迫在眉睫。文章拟以制度经济学和福利经济学等学科的理论为依据，总结我国城镇和农村医疗保障的实践经验，提出解决上述问题的主要思路：在城镇职工基本医疗保险制度、农村新农合措施以及医药卫生体制改革的背景下，以基本医疗保险制度作为主体框架，逐步构建包括多种医疗救助形式的、多层次的全民医疗保障体系，建立稳定并且多元化的筹资机制和可持续发展机制，最终实现城乡医疗保障体制的统一。     

大学生一般自我效能感、安全感与心理健康的关系研究

采用问卷调查法对332名大学生进行了研究,试图考察大学生一般自我效能感、安全感与心理健康的关系.结果表明:(1)一般自我效能与安全感及各因子存在正相关,与心理健康及各因子存在负相关,安全感与心理健康及各因子存在负相关；(2)一般自我效能感在安全感和心理健康之间存在着调节作用.     

Interdisciplinary cooperation to combat health care violence: still a long way to go

Hesitancy in the past on the part of JCAHO, AMA, ACEP, and other influential health care industry organizations to even recognize that a need for security exists is giving way to voiced concern about increasing violence directed at physicians and other health care professionals, as well as patients. However, the industry's movers and shakers still profess a hands-off approach when it comes to working together with security professionals to take specific steps to reduce violence. Nevertheless, there has been some progress, albeit slow, by physicians and other professionals in drawing on the experience and expertise of security professionals. In this report, we'll bring you up to date on the current status of interdisciplinary cooperation, including some examples of actual cooperation between security directors and two other health professionals--social workers and mental health officials--to spot persons prone to violence before they act.     

Security, insecurity and health

An examination of the nexus of security, insecurity and health shows that security is a prerequisite for health. The many and varied ways that armed violence--including threats of armed violence--can affect people's health can be documented by formal studies; however, valuable data also exist in other reports, such as media reports. The health community needs to recognize that people's insecurity is a massive global health issue. The foreign policies of donor governments should incorporate recognition that documentation, analysis and publication of data describing the impact of insecurity on people's health can lead to the creation of policies to enhance people's security.     

Health data security: a new priority

As more health care information is computerized, concerns about the security of on-line data are growing. Some well-publicized health data security breaches illustrate the potentially devastating impact of confidentiality violations. This package of stories offers and in-depth look at the state of health data security. It includes a "roundtable discussion" by five prominent chief security officers, as well as articles on data encryption, biometrics, legislation and other topics.     

Putting food on the public health table: Making food security relevant to regional health authorities

Food security is emerging as an increasingly important public health issue. The purpose of this paper is to describe a conceptual model and five classes of food security indicators for regional health authorities (RHAs): direct, indirect, consequence, process, and supra-regional. The model was developed after a review of the food security literature and interviews with British Columbia community nutritionists and public health officials. We offer this conceptual model as a practical tool to help RHAs develop a comprehensive framework and use specific indicators, in conjunction with public health nutritionists and other community stakeholders. We recommend using all five classes of indicator together to ensure a complete assessment of the full breadth of food security. This model will be useful for Canadian health authorities wishing to take a holistic community-based approach to public health nutrition to develop more effective policies and programs to maximize food security. The model and indicators offer a rational process that could be useful for collaborative multi-stakeholder initiatives to improve food security.     

Evaluating career values of dietetic students. A model for other allied health professions

Increased job opportunities in health professions make recruitment of students imperative. Effective recruitment requires a knowledge of what students value when making career decisions. This study of dietetic (n = 514) and other college students (n = 352) showed that achievement and economic security were the most important factors in their career selection regardless of major or race. Dietetic majors rated achievement, economic security, ability utilization, personal development, altruism, and working conditions significantly higher than did nondietetic students (p < or = 0.001). Economic security was rated significantly more important by dietetic and allied health majors than by other students. Many of the values important to students in this study are attainable through careers in dietetics and other allied health professions. The results of this study should be examined further with a larger sample of allied health majors to assist educators in recruiting and providing career counseling to students.     

Administrative and security challenges with electronic patient record systems

EPRS security is clearly an area of concern to all health information management professionals. With the advent of enterprise-wide linkages, as well as community health information networks (CHINs) and other remote linkages, security is a critical issue that must be addressed in detail during system selection and implementation. Strict enforcement of security policies and procedures is mandatory. Technology has given health information management professionals the tools to secure the patient record. Use of these tools is required to meet the challenges presented by the transition to the electronic realm.     

Financial security and public health: How basic income & cash transfers can promote health

ABSTRACT

Inadequate financial resources are a major driver for poor health. Financial insecurity contributes to health inequities in mutually reinforcing ways, with some effects lasting years. Fostering financial security to reduce the likelihood or magnitude of such pressures would have significant present and future health benefits. We review several models for bolstering financial security to determine which have the most significant health contributions based on current evidence and their theoretical potential. We hypothesise that basic income guarantees might have the greatest positive health impact for beneficiaries, though this is heavily contingent on programme design and how financing affects other social welfare programmes. Cash transfer programmes also contribute to financial security and promote health, with particularly strong evidence for the health benefits of conditional cash transfers, and may be more feasible programmes in some contexts.     

关于建立农村健康保障制度的构想

农村应建立一个覆盖农村的统一的法定的基本健康保障和以其他补充健康保障模式的多层次,高弹性的健康保障体系,并根据不同地区的经济情况,政府给予不同的转移支付;建立农村最低生活保障制度,并对处在最低生活水平之下的农民给予医疗救助,农村基本健康保障基金由社会保障税,政府投资,转移支付和其它社会资金四个部分组成,主要用于医疗保险、医疗救助,公共卫生体系及其他投资,此外还提出相关配套改革,以逐步建立农村健康保障制度。     

What's public? What's private? Policy trade-offs and the debate over mandatory annual influenza vaccination for health care workers

Policy decisions about public health services differ from those for personal health services. Both require trade-offs between such policy goals as liberty, security, efficiency, and equity. In public health, however, decisions about who will approve, pay for, and deliver services are often accompanied by decisions on when and how to compel individual behaviour. Policy becomes complex because different stakeholders interpret evidence differently: stakeholders may assign different weights to policy goals and may even define the same goals differently. In the debate over mandatory annual influenza vaccination for health care workers, for example, proponents as well as opponents of mandatory vaccination may convey arguments in security terms. Those in favour of mandatory vaccination emphasize subclinical infections and duty of care (public security) while those opposed emphasize risk of adverse events (personal security). Proponents assert less worker absenteeism (efficiency) while opponents stress coercion and alternate personal infection control measures (liberty and individual rights/responsibilities). Consequently, stakeholders talk past each other. Determining the place of mandatory influenza vaccination for health care workers thus demands reconciling policy trade-offs and clarifying the underlying disputes hidden in the language of the policy debate.