农村县乡卫生机构的功能定位及调整政策研究

农村卫生问题是我国卫生工作的重点,长期以来作为农村卫生工作基本载体的县、乡、村三级卫生保健网在保障农村居民健康、促进农村经济发展等方面发挥了巨大作用。但随着农村经济体制的变革、农民生活水平的提高以及小城镇建设的发展,农村三级卫生机构在布局和功能上都出现了一些新的亟待解决的问题。因此对农村县乡两级卫生机构进行调整与改革,明确职责,减少交叉与重叠,加强服务功能,是促进县乡两级卫生机构运行机制步入良性循不的关键所在。报告分为两部分,第一部分为县级卫生机构功能定位及调整政策研究,第二部分为乡镇卫生院功能定位及调整政策研究。     

社会资本投资于医疗服务领域的相关政策

目前,我国开放医疗服务市场,鼓励社会资本投资于卫生领域,需要明确几个重要的相关政策:打破行政垄断,放宽市场准入;平衡卫生服务的规划指导与市场竞争的关系;在市场开放的同时,必须保证基本医疗服务需求;明确社会资本投资与卫生的重点和途径;完善分类管理政策和公立医院向民办营利性医院和非营利性医院转制的政策;鼓励公立医院的管理体制和治理结构创新;加强对医疗服务市场的监管,克服市场失灵.     

个人和公共卫生支出对城乡居民收入差距的影响

健康和教育一样,是人力资本的重要组成部分,因此健康状况也影响人们的收入。健康状况受许多因素的影响,但主要是对健康的投资,包括公共部分和个人部分。本文分析了中国1980年以后个人和公共卫生支出对城乡居民收入差异的影响。结果显示,城乡个人医疗保健支出比例增大,城乡居民收入差距也会扩大,而公共卫生支出增加和农村社保投资比重加大都有助于缩小城乡收入差距。     

The role of payment and financing in achieving health equity

Objective

The aim was to identify healthcare payment and financing reforms to promote health equity and ways that the Agency for Healthcare Research and Quality (AHRQ) may promote those reforms.

Data Sources and Study Setting

AHRQ convened a payment and financing workgroup–the authors of this paper–as part of its Health Equity Summit held in July 2022. This workgroup drew from its collective experience with healthcare payment and financing reform, as well as feedback from participants in a session at the Health Equity Summit, to identify the evidence base and promising paths for reforms to promote health equity.

Study Design

The payment and financing workgroup developed an outline of reforms to promote health equity, presented the outline to participants in the payment and financing session of the July 2022 AHRQ Health Equity Summit, and integrated feedback from the participants.

Data Collection/Extraction Methods

This paper did not require novel data collection; the authors collected the data from the existing evidence base.

Principal Findings

The paper outlines root causes of health inequity and corresponding potential reforms in five domains: (1) the differential distribution of resources between healthcare providers serving different communities, (2) scarcity of financing for populations most in need, (3) lack of integration/accountability, (4) patient cost barriers to care, and (5) bias in provider behavior and diagnostic tools.

Conclusions

Additional research is necessary to determine whether the proposed reforms are effective in promoting health equity.     

Mental Health and Substance Abuse Spending by Age, 2003

This article presents national estimates of mental health and substance abuse (MHSA) spending in 2003 by age groups. Overall, $121 billion was spent on MHSA treatment across all age groups in 2003. Of the total $100 billion spent on MH treatment, about 17% was spent on children and adolescents, 68% on young and mid-age adults, and 15% on older adults. MH spending per capita by age was $232 per youth, $376 per young and mid-age adult, and $419 per older adult. Of the total $21 billion spent on SA treatment, about 9% was spent on children and adolescents, 86% on adults ages 18 through 64, and 5% on older adults age 65 and older. SA spending per capita by age was $26 per youth, $98 per mid-age adult, and $28 per older adult.     

The Role of Evidence in Health Policy Making: A Normative Perspective

Assessment of evidence is becoming a centralpart of health policy decisions – not least inlimit setting decisions. Limit-settingdecisions can be defined as the withholding ofpotentially beneficial health care. Thisarticle seeks to explore the value choicesrelated to the use of evidence in limit-settingdecisions at the political level. To betterspecify the important but restricted role ofevidence in such decisions, the value choicesof relevance are discussed explicitly. Fourcriteria are often considered when settinglimits:1. The severity of disease if untreated or treatedby standard care2. The effectiveness of the new technology3. The cost-effectiveness of the new technology4. The quality of evidence on (1)–(3)The production and assessment of evidence isimportant for each criterion, but severalpoints are identified where the practice ofevidence-based medicine could be furtherdeveloped to capture a broader spectrum ofethical and political concerns that suchdecisions naturally evoke among citizens.     

柳州市基层医疗卫生机构儿童保健服务能力调查

目的:了解柳州市基层医疗卫生机构儿童保健服务能力现状,为相关部门制定政策提供参考依据。方法:采用普查的方式调查柳州市123家基层医疗卫生机构的辖区基本情况、人员及设施设备投入和服务开展情况。结果:123家基层医疗卫生机构中,每万常住人口拥有基层医疗卫生机构儿童保健医生0.32名、注册护士0.25名,每平方公里儿童保健医生0.0070名、注册护士0.0055名。39.84%的机构无执业(助理)医师,32.52%的机构近5年有儿童保健人员到上级医院进修。儿童保健门诊用房面积达到自治区要求的机构不足40%;视力检查、听力筛查、心理行为发育评估和膳食营养分析工具配置率分别为89.43%、36.59%、22.76%和9.76%。开展的7项儿童保健服务中,心理行为发育测验(24.39%)、耳及听力保健服务(74.80%)开展比例低,其他5项均超过90%。城乡机构间儿童保健服务人员、设施设备投入和服务开展情况存在差异,贫困县情况更严峻。结论:柳州市基层医疗卫生机构儿童保健服务能力与国家标准相比,还存在一定差距。政府有必要合理配置医疗资源,加强儿童保健人员的培养,规范儿童保健门诊建设,全面提高基层医疗卫生机构儿童保健服务能力。     

经济学视野下的健康与卫生政策研究

在整体方面,经济学认为健康是劳动力与资本,是社会经济体系中最主要的生产要素;在个体方面,经济学认为健康是人力资本,是能提高消费者满足程度的耐久资本品;经济学在稀缺性、替代性和异质性等3个基本概念上对卫生政策与卫生资源的合理配置产生了深刻的影响;经济学评价与实证研究以及规范性研究等不同的经济学研究方法也为卫生政策的研究提供了科学的决策依据。     

定西市乡镇医疗机构卫生人力现状及需求调查分析

目的为合理配置乡镇卫生人力结构提供科学依据。方法采用整群抽样的方法,抽取定西市安定区7所乡镇医疗机构．对其医疗卫生服务情况及其卫生人力资源状况进行调查。结果定西市乡镇医疗机构卫生人员的专业学历以大、中专毕业生为主,分别占40．2％和46．0％;卫生人员的职称以助理为主,为51．7％;乡镇医疗机构卫生人员现有需求量远不能满足近期需求总量。结论定西市乡镇医疗机构卫生人力总体学历偏低．性别年龄结构、专业和职称结构均不合理。卫生人力专业结构差异较大．专业素质有待提高,人力资源总量应按照需求增加。建议适度加大对乡镇卫生人力资源的总量投入,通过区域性卫生人力规划．合理配置卫生资源．提高卫技人员整体学历职称结构,有效提高居民卫生服务的利用率。     

什么是"好"的卫生政策

医药卫生体制改革已进入攻坚和关键阶段,宏观、前瞻、科学的卫生政策指导与深厚社会关怀、社会健康理论支持已成为继续深化卫生体制改革发展战略措施和战略议题。如何科学民主决策,如何创造性地制定优秀的卫生政策框架,是卫生改革发展成功的前提。     

Chronic Pain and Health Care Spending: An Analysis of Longitudinal Data from the Medical Expenditure Panel Survey

ObjectiveTo estimate average incremental health care expenditures associated with chronic pain by health care service category, expanding on prior research that focused on specific pain conditions instead of general pain, excluded low levels of pain, or did not incorporate pain duration.ConclusionsChronic pain limitations are associated with higher health care expenditures. Results underscore the substantial cost of pain to the health care system.     

浅谈重庆市医疗卫生机构既有建筑综合节能管理

医疗卫生机构是公共建筑中一个重要而特殊的领域,在医疗卫生系统中推广节能工作,意义十分重大。本文通过对重庆市医疗卫生机构能源消耗情况分析,并结合部分实例,提出在医疗卫生机构开展既有建筑综合节能管理的方法和对策。     

医疗卫生机构推行财务共享服务的探讨

在分析国家政策需求和医疗卫生机构财务管理现状的基础上,提出在医疗卫生机构推行财务共享服务,以期促进财务转型,进而达到卫生行政主管部门和医疗卫生机构双赢的效果。     

The Impact of Health Care Policy Initiatives on Productivity

This paper analyses productivity growth in health care delivery in Sweden and the impact of health care policy initiatives on productivity. In particular we consider the maximum waiting time guarantee introduced in Sweden 1992. The intention of the maximum waiting time guarantee was to shorten the waiting lists, partly through increased productivity. We measure productivity growth by estimating Malmquist productivity indices using non-parametric linear programming models. The productivity models are applied to data from a sample of public ophthalmology departments from 1988 to 1993. Positive productivity changes are found in several years, although no significant differences between the periods are found. © 1997 by John Wiley & Sons, Ltd.     

湖北省县级医疗机构现状及对策

采用描述性分析方法,从5个方面(卫生人力、财政补助、固定资产、经济运营、医疗服务利用)对湖北省县级医疗机构现状进行了分析,提出县级医院应立足县城,面向乡村,以发展农村医疗服务为己任,并针对性地提出了当前县级医院进一步深化改革的建议。     

社区卫生发展及筹资与补偿政策

社区卫生服务是城市公共卫生和基本医疗服务体系的基础,是实现人人享有初级卫生保健的基本途径。为群众提供更为方便、快捷的医疗服务,同时,为大医院分流病人缓解压力。目前,社区卫生的发展面临着人、财、物的匮乏问题,解决社区卫生的筹资渠道及建立相关的补偿政策是问题的关键。     

The Role of Primary Care in Improving Population Health

Policy Points

• Systems based on primary care have better population health, health equity, and health care quality, and lower health care expenditure.
• Primary care can be a boundary-spanning force to integrate and personalize the many factors from which population health emerges.
• Equitably advancing population health requires understanding and supporting the complexly interacting mechanisms by which primary care influences health, equity, and health costs.