初级卫生保健中的伦理道德观

初级卫生保健是 WHO 为实现“二○○○年人人享有卫生保健”这一全球目标而提出的战略措施。中国作为初级卫生保健的故乡,已将实施初级卫生保健纳入发展我国社会经济和城乡卫生事业的总体规划之中。由于初级卫生保健在卫生观念、防治手段和服务方式等方面出现了一系列     

支付方式对初级卫生保健医生行为的影响

与初级卫生保健医生相关的支付方式有三种:薪酬支付、总额预算支付和按服务项目支付。本文通过对三种支付方式在初级卫生保健服务中的激励作用进行比较分析,评价了支付方法对初级卫生保健医生行为的影响。     

《中国初级卫生保健》1989年选题参考

1.对我国2。。。年实现“人人享有卫生保健,前景的展望 2.初级卫生保健的理论及发展 8.初级卫生保健组织建设与管理 4。实施初级卫生保健的做法和体会 5.城市初级卫生保健研究 6.如何制定本地区初级卫生保健规划 7。实施初级卫生保健的指标体系与评价 8.国外初级卫生保健发展情况介绍 9.农村医疗保健制度研究与实践 10.合作医序效益评价 11.关于农村卫生人员培训方式与内容探讨 12。社会、自然、心理因素与人群健康关系 13.初级卫生保健系统研究与管理 14.乡镇企业职业危害控制对策的研究 15 .WHO动态 16.全国农村卫生协会活动情况 17。人…     

城市初级卫生保健的概念与内容

近几年来,在卫生部的重视和积极倡导下,农村初级卫生保健工作逐渐得到了国内医学卫生界的关注和支持。但是在城市初级卫生保健的基本概念、服务对象、工作范围和实施的方式、方法等方面如何更好地结合我国实际情况,在认识尚不一致。如何开展城市的初级卫生保健成了卫生工作的另一个重要课题。世界卫生组织确立的初级卫生保健的概念比较明     

第五次全国农村卫生经济学术讨论会召开

第五次全国农村卫生经济学术讨论会9月1日～6日在北戴河召开。本次会议的主题是“PHC经费的筹集与使用”。这是学术界第一次专题研讨初级卫生保健有关的经费问题。有21篇论文参加了大会交流。会议期间代表们就初级卫生保健费用与发展我国农村卫生事业的关系,初级卫生保健费用的内涵、项目构成,筹集初级卫生保健经费的渠道及方式,初级卫生保健经费的分配原则,初级卫生保     

我国城市实现“2000年人人享有卫生保健”的若干问题探讨

城市初级卫生保健是2000年人人享有卫生保健战略目标的重要组成部分,是解决城市卫生问题,提高城市居民健康水平的重要途径。1985年以来,上海、北京、哈尔滨、烟台等城市,相继开始了城市初级卫生保健的实践和理论探索;1990年8月我利曾系统地介绍了哈尔滨市道外区城市初级卫生保健的经验。随着这项工作的逐渐展开,需要对城市初级卫生保健工作涉及的政策、体制、方式、方法等一系列问题作出回答。为此,我们组织了这组专栏文章,其中有理论探讨,亦有经验介绍,希望能对城市初级卫生保健工作的开展起到推动作用。     

农村初级卫生保健理论研究的新进展

随着我国农村初级卫生保健工作的深入普及,有关初级卫生保健的理论研究工作呈现出可喜的局面。1992年是我国建国40余年以来,农村卫生和初级卫生保健理论研究跃上新台阶的一年,主要为:①初级卫生保健管理的研究;②世界卫生组织中国农村初级卫生保健合作中心十年工作经验的理论总结;③实施初级卫生保健适宜技术与基本药物的研究。在以上几方面研究的基础上,正式编辑出版了《初级卫生保健管理》、《中国农村初级卫生保健指导手册》、《初级卫生保健在中国——中国农村世界卫生组织初级卫生保健合作中心资料汇编》和《中国农村初级卫生保健适宜技术与基本药物手册》,受到了国内外卫生界的瞩目。     

新时期农村初级卫生保健事业发展的思考

21世纪的新一轮农村初级卫生保健取得了新进展。在新时期推进农村初级卫生保健意义重大。要正确认识现阶段农村初级卫生保健面临的新问题和挑战。农村初级卫生保健重点要抓好农村卫生服务体系建设、人才队伍建设和新型农村合作医疗制度建设,要立足于建立长效机制促进农村初级卫生保健工作任务的落实。     

从化推行初级卫生保健部门间协调的规定

为动员社会各部门参与初级卫生保健,1989年1月从化县政府将我县的初级卫生保健领导小组扩大部门参与,成立了县初级卫生保健委员会,由政府、财政、农业、卫生、教育等15个部门领导人组成,负责全县初级卫生保健的组织,规划协调、发展和管理,委员会制订出各部门在开展初级卫生保健过程中需履行的职责和义务,以体现初级卫生保健的精神。随后,具体规定了各部门需承担的初级卫生保健工作的职责和任务: 县政府负责组织领导全县的初级卫生保健的规划、实施和管理,协调工作,全县各部门积极履行本部门需承担的初级卫生保健职责:动员本县群众团体,社会团体以至全民共同参与初级卫生保健活动;对全县卫生投资做到合理化,争取卫     

充分发挥健康教育在PHC工作中的先导作用

健康教育是实施初级卫生保健(PHC)的基础和先导。通过健康教育,可以改变人们的不卫生行为和不良的生活方式,提高人们自我保健能力,调动广大群众积极参与初级卫生保健的各项工作。我们在PHC工作中,强化健康教育的先导作用,为推动初级卫生保健试点工作的顺利开展起到了积极的促进作用     

Measuring attitude toward social health insurance

In order to understand the health care system a country chooses to adopt or the health care reform a country decides to undertake, one must first be able to measure a country’s attitude toward social health insurance. Our primary goal was to develop a construct that allows us to measure this “attitude toward social health insurance”. Using a sample of 724 students from the People’s Republic of China, Germany, and the United States and an initial set of sixteen items, we extract a scale that measures the basic attitude toward social health insurance in the three countries. The scale is internally consistent in each of the three countries. A secondary factor labeled “government responsibility” is marginally consistent for the total sample and for the German sample. German respondents have the most favorable attitude toward social health insurance, followed by China, and then the United States. Chinese respondents have the most favorable attitude toward government responsibility in health insurance. The scale developed here can be used to further investigate and understand which health care system will succeed and which will fail in a given country, which is important from both a political and an economic perspective.     

Advancing primary care to promote equitable health: implications for China

China is a country with vast regional differences and uneven economic development, which have led to widening gaps between the rich and poor in terms of access to healthcare, quality of care, and health outcomes. China's healthcare reform efforts must be tailored to the needs and resources of each region and community. Building and strengthening primary care within the Chinese health care system is one way to effectively address health challenges. This paper begins by outlining the concept of primary care, including key definitions and measurements. Next, results from a number of studies will demonstrate that primary care characteristics are associated with savings in medical costs, improvements in health outcomes and reductions in health disparities. This paper concludes with recommendations for China on successfully incorporating a primary care model into its national health policy, including bolstering the primary care workforce, addressing medical financing structures, recognizing the importance of evidence-based medicine, and looking to case studies from countries that have successfully implemented health reform.     

欧洲重建初级卫生保健服务体系的理念与措施

越来越多的欧洲国家政府开始呼吁重建初级卫生保健服务体系,很多国家已经采取了一系列的改革措施来强化初级卫生保健服务体系。由于在社会经济背景、改革理论依据和价值取向等方面的差异,各国逐步形成了各具特色的初级卫生保健服务模式。这些模式的特点包括集治疗、康复和预防,以及健康促进等工作为一体,基于初级卫生保健服务来改善卫生服务的供给,突出以人为本的卫生保健服务特色,强调卫生服务的协调性与整体性,提供综合、连续、可获得的卫生保健服务等。这也为我国完善初级卫生保健服务体系提供了许多经验。     

理性评估中国医改三年成效

新一轮医改三年来进展顺利,在促进基本公共卫生服务逐步均等化、加快推进基本医疗保障制度建设、初步建立国家基本药物制度、健全基层医疗卫生服务体系、推进公立医院改革试点等方面取得明显成效,基层基本医疗卫生制度模式初现雏形。理性评价医改三年的成效,客观分析其中存在的问题,直接影响到进一步推进和完善医改。本文根据评估标准,对三年医改成效、进展和制度建设进行评估,并就下一步医改面临的挑战提出政策建议。     

Devolved budgetary responsibility in primary care

General Practitioners and primary care physicians have a pivotal role in the allocation of health care resources in most countries. With increasing costs of care, they have therefore become a significant focus for healthcare reform in the pursuit of increased efficiency. For example, the United Kingdom (UK), United States of America (USA), New Zealand (NZ), Germany and The Netherlands, have all pursued reforms introducing explicit budgetary responsibilities for primary care. While there is a common set of objectives underlying such budgetary responsibilities, different versions have been introduced to reflect specific health environments. As most of these reforms were introduced in the early to middle 1990s, it is timely to examine their impact on efficiency. This paper therefore provides an econometric assessment of the effect of budgetary arrangements in the UK, USA, NZ, Germany and The Netherlands on the growth of primary care expenditure and flow-on costs (as proxied by pharmaceutical expenditure), as proxy indicators for efficiency. The results suggest that for all countries there is some support for efficiency improvements through the implementation of budgets for primary care.     

Some Aspects of the Reform of the Health Care Systems in Austria, Germany and Switzerland

The health care systems in Austria, Germany and Switzerland owe theirinstitutional structure to different historical developments. While Austriaand Germany voted for the Bismarck-Model of social health insurance,Switzerland adopted a voluntary system of health insurance. In all threecountries, until very recently, the different challenges which the healthcare sector faced were met by piecemeal approaches and by stop and gopolicies, which, in the long run were not very successful either incontaining costs or in improving efficacy and efficiency. During the 1990 morefundamental reforms in the health care systems of all three countries tookplace. Germany and Switzerland chose the path of deregulation of thehealth insurance system, which consequently strengthened the competitionbetween the insurance companies, and, to some extent between thesuppliers of medical services. While this can be seen as an essential part ofthe reform process for these two countries, Austria favors a state-orientedand interventionist approach in order to meet the challenges.     

中国医疗卫生:挑战与出路

疾病风险可以引发经济风险、社会风险甚至政治风险。国内外都对疾病风险的防范给予高度重视,很多国家通过制度为百姓提供医疗保障,化解由疾病风险引发的其他风险。通过对中国疾病风险严重程度的分析,指出“看病难、看病贵”问题的核心原因是政府公共服务职能的缺失,这种缺失表现为社会保障制度的缺失和医疗公共筹资制度的弱化。为此,在发展战略选择上,主张选择以健康为核心的发展战略,以改革推动事业发展。在改革路径选择方面,提出以筹资模式的转变为突破口,促进医疗卫生服务管理模式、服务模式以及就医模式的转变。从而,全面实现推动以健康为核心的发展模式。     

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。     

中国医药卫生体制改革与中国卫生政策研究类型

中国医药卫生体制改革处于总体制度框架设计与改革发展模式选择的关键时刻，改革发展实践迫切需要卫生政策研究。卫生政策研究质量决定卫生改革的成败。卫生政策研究在医药卫生制度框架设计、发展模式选择、体制改革实践、卫生保健体系创新、医院质量管理和构建和谐医患关系等工作中扮演基础性和核心角色，发挥举足轻重的作用。本文简要论述医药卫生体制改革与卫生政策研究关系，介绍中国卫生政策研究的基本类型。     

Exploring health care reform in a changing Europe: Lessons from Greece

Abstract

The economic crisis is the major theme in the Eurozone and its impact on public health and outcomes is largely discussed. Under this pressure, concerns of further inequalities exist that may have an impact on the burden of several diseases in certain European countries. In this context, Greece is currently an issue of top interest in any international economic discussion. Although the background of the recession has been largely discussed as a political crisis, its health effects on the population, as well as the key role of primary care and general practice/family medicine in health care reform remain to be explored. Serving both the worldwide trend of orienting health care systems towards strengthened primary care and the inner need for minimizing the demand and lessening the burden from the dysfunctional and costly hospital-care system, the economic crisis sets the perfect timing for prioritizing primary health care. In this article a unique window of opportunity for health care reform in Greece is examined, attempting to establish the axes of an example of how health care system can be reshaped amidst the economic crisis. Equity, quality, value framework, medical professionalism, information technology and decentralization emerge as topics of central interest. There is no doubt that Europe is transitioning under challenging social, economic and public health perspectives. However, taking Greece as an example, the current economic situation sets a good timing for health care reform and the key messages of this paper could be used by other countries facing similar problems.