Training health services managers: improving health by more health economics?

In times of rising health expenditures and imminent health problems, efficiency is a crucial element for maintaining and improving health care and, finally, health. One major support measure is the effective management of health services. This paper considers possible improvements of health care by training health services managers in health economics. It surveys the current state of health economics training, presents approaches towards the key issues of health economics, discusses the impact of health economics by two examples, and considers management aspects of health economics training.     

上海市商业健康保险制度研究

通过对国际医疗保健模式的比较和国内社会医疗保险及商业健康保险的分析,并结合高端医疗服务的现状,提出建立适应上海高端人群医疗服务特点的上海商业健康保险新模式。基本医疗服务由社会保险给予支付,高端医疗服务通过分类给付办法,即在社会医疗保险支付基本医疗服务费用基础上,其余费用由商业健康保险给予支付。基本医疗保险与商业健康保险相结合,满足不同层次人群对医疗服务的需求。     

我国乡镇卫生院公共卫生管理功能定位思考

通过分析目前我国农村乡镇卫生院公共卫生管理的现状，探讨农村乡镇卫生院公共卫生功能，提出我国农村公共卫生管理范畴定位。从而明确乡镇卫生院公共卫生管理范畴，促进农村卫生三级网络的建设和完善，更好的发挥乡镇卫生院在农村卫生工作中的作用，推动农村公共卫生事业的健康发展，促进农村居民的健康。     

Beginn der Routinephase Gesundheitsberichterstattung des Bundes

The federal German health reporting system, financed by the Federal Ministry of Health, is monitoring the status of health, health behaviour, risk factors, health care utilisation, costs and resources of the health care system on the national level. The health reports offer action-oriented information on health related topics and provide a scientific basis for health policy decisions. This paper gives an overview on upcoming topics of the health report and briefly describes how the health reporting system is organised by the Robert Koch-Institute. Beside the health monitoring on national level the federal health reporting system co-operates with other health reporting systems on sub- and international level.     

健康危险因素与个体健康间的结构方程模型

目的探索健康危险因素与个体健康间的潜在关系,以及各潜变量对测量指标的影响。方法利用健康风险评估调查问卷调查西安市某三级甲等医院健康体检人群。构建健康危险因素与个体健康间的结构方程模型,解释不同因子间的相互作用及其对总体健康的效应权重。结果健康行为与健康意识之间呈显著正相关。健康行为对躯体健康的直接效用为0.85,健康意识不仅直接作用躯体健康,而且通过对心理健康的影响对躯体健康产生间接效应,总效应达0.78。结论健康行为、健康意识均是可控的健康危险因素,对躯体健康、心理健康产生一定影响。通过改变这些可控因素可以提高人们整体健康水平。     

Health educators' role in promoting health literacy and advocacy for the 21st century

This article discusses the relationship between health literacy and advocacy for health and health education, cites achievement of advocacy as a critical outcome of health education, and identifies health advocacy competencies for both students and health educators. The paper also delineates a role for health education in developing health-literate citizens and in training health educators to advocate for health and health education. The article draws on recent initiatives in comprehensive school health education and coordinated school health programs to identify content and strategies for developing health advocacy skills among elementary, middle, and senior high school students. The article provides a variety of approaches and strategies for developing advocacy skills among preservice and inservice health educators.     

21世纪卫生系统改革对卫生经济学发展的影响

该文介绍了发达国家和发展中国家在卫生改革中遇到的问题。前者有：组建医院间“战略联盟”,管理保健市场发展,卫生服务效率、公平性和可及性等。后者有：减少政府的作用,改变公共部门的组织及管理,增加卫生资金的来源及数量。这些问题引起卫生经济学界关注。第二次国际卫生经济学会会议将讨论以下专题：信息不对称及卫生保健组织间关系、卫生保健的选择,卫生及卫生服务的需求,健康及卫生服务的分布,卫生保健的经济学评价,卫生保健市场分析,健康保险,管理保健,卫生服务的产出等18个主题。     

Public health management: Time for a new start?

One of the themes of health care reform Is a renewed focus onhealth rather than health care. The role of the purchaser isdirected towards health gain rather than merely the maintenanceof health care services. This goal can only be achieved if publichealth specialists and health services managers work togetherand share skills. There is a need for public health physicians,non-clinical public health specialists and health service managersto find an intellectual focus for joint working since theirrespective skills are complementary. Whereas public health haslooked outwards towards the health needs of the population,health care management has focused inwards on the organizationof health services. The concept of public health managementoffers a unifying focus. It centres on the mobilization of society'sresources, including those of the health service sector, toimprove the health of populations through whatever means ismost appropriate. Public health has suffered from a tensionbetween knowledge and action. Public health management seeksto resolve this tension. The paper explores the concept of publichealth management, analyses the skills required for its successfulpractice and considers the training programmes required to developpublic health managers. The authors call on European organizationsto champion the concept of public health management.     

我国基层卫生机构服务功能分析

基层卫生机构功能决定着基本卫生服务的供给。本文利用国家第四次卫生服务总调查以及专题调查资料,对城乡基层卫生机构服务开展情况进行了分析。根据经济社会发展水平、基层卫生机构服务能力和城乡居民需要解决的主要健康问题,本研究将基本卫生服务项目按照优先程度分为三个等级。约三分之一的城乡基层卫生机构尚不能提供最应优先开展的基本卫生服务;农村基层卫生机构服务能力与城市基层卫生机构相比更为薄弱,特别是村级卫生机构基本卫生服务能力需要加强;乡镇卫生院和社区卫生服务中心开展最优先项目的比例均不足70%;村卫生室和社区服务站开展最优先项目比例分别为62%和77%。影响基层卫生机构功能的主要因素为人员数量不足、人员能力不够、缺乏运转资金等。需要以基层卫生机构功能建设为核心,创新我国基本医疗卫生保健体系。     

新疆公共卫生服务供给存在的问题和对策

为实现公共卫生服务均等化的目标,分析了新疆公共卫生供给中面临的主要问题是基层医疗卫生经费投入不足,政府对公共卫生机构投入不足,基层卫生资源配置不足,公共卫生人才不足、素质较低,公共卫生服务成本较高,公共卫生服务供给不足。从加大政府对公共卫生的投入、科学设计均等化服务项目、整合卫生资源,加快人才培养等方面提出了建议。     

An analysis of health levels and various indicators of urban environments for Healthy Cities projects

STUDY OBJECTIVES: (1) To identify and to categorise the various city indicators that are related to health levels; (2) to demonstrate the extent of the influence on health of these categorised health determinants; and (3) to demonstrate both the interactive associations among the health determinants and the magnitude of influence of each health determinant on the people's health. DESIGN: By using city statistics of study areas, the health index and health determinant indices were formulated. The extent of influence of health determinants on the health index was examined by regression analysis; the interrelations between the health determinants and the health index were examined by correlation analysis. SETTING: All the administrative units in Japan with populations more than 100 000 were selected as study areas to analyse the relation of health and health determinants. MAIN RESULTS: The nine health determinant indices used-healthcare resources, preventive health activities, environmental quality, housing, urban clutter, local economy, employment, income, and education-explained 51.6% of the variances of the health index as a whole in the cities studies. The health determinant indices showed interrelations with each other, in addition to individual health determinant indices having a high correlation with the health level index of the population. CONCLUSIONS: Both individually and collectively the health determinants are closely related to the health status of a population and individual determinants interact with each other. Simultaneous analysis of the interrelations among health determinants and health status would contribute to widen integration oriented perspective in policy interventions based on collaboration between different sectors of society.     

广西卫生事业发展现状分析

从健康水平、妇幼保健、卫生机构、卫生人力、卫生床位、医疗服务、传染病疫情、卫生经费等多角度分析广西卫生事业发展现状,并与全国平均水平进行比较。结果表明,近年来广西卫生事业发展水平不断提升,居民主要健康指标总体优于全国平均水平;卫生资源总量持续增加;社会资本办医成效显著,民营医院发展迅速;卫生筹资结构在不断优化,个人卫生负担有所减轻。但也面临妇幼保健体系有待完善、卫生人均量不足、基层医疗卫生资源利用不足、医疗费用持续上涨、法定传染病报告发病率上升、社会卫生筹资不足以及农村居民人均医疗保健支出增长过快等问题。因此,广西卫生事业发展综合水平还有待进一步提升。     

山东省农村老年人健康知识现状及影响因素分析

目的了解农村老年人健康知识水平现状及其影响因素,为政府部门制订相关策略和措施,以提高农村老年人健康知识的知晓率,促进其身心健康提供理论依据。方法采用分层随机抽样方法抽取山东省11个地市的农村老年人610人,对农村老年人健康知识现状进行统计描述,对其影响因素用非条件多元Logistic回归进行分析。结果农村老年人健康知识知晓率低;农村老年人主要通过电视广播、亲朋好友和医疗保健机构获得健康知识;农村老年人健康知识水平的影响因素有婚姻状况、文化程度、户口类型、是否主动了解健康知识以及村是否开展健康教育。结论政府部门应根据老年人喜爱的途径,针对重点影响因素采取不同的干预措施,提高老年人健康知识水平,增强自我保健意识,促进老年人身体健康。     

Public health and the health system. SESPAS Report 2010

Analysis of the relationship between public health and the health system requires definition of a conceptual framework and the choice of a particular context. The chosen context of this discussion is the management of public organizations. With this in mind, functions will be associated with organizational macroprocesses. From this point of view, this article identifies the functions-processes that any health system should develop and their goals. The current situation of public health in the health system is analyzed through the study of public health budgets and the place they occupy in the hierarchy of the health departments of the autonomous communities. The "public health" budget program represents an average of 1.34% of health expenditure in the autonomous communities in 2010. Over 20% of public health organizations of the autonomous communities have a rank lower than general directorate. These data indicate the low weight assigned to public health in the health systems of the Spanish state. To change this situation, consensus must be reached on the desired relationship between public health and the health system. Such a consensus would then have to be accepted and work would have to be undertaken to improve results. Three alternatives are proposed: (i) public health would be an organization that would be above or outside the health system; (ii) public health would be synonymous with the public health system; and (iii) public health would form part of the health system with a range of assigned functions. Finally, we provide some recommendations to help define the most effective and efficient relationship between public health and the health system.     

Self-rated health in rural Appalachia: health perceptions are incongruent with health status and health behaviors

Background  

Appalachia is characterized by poor health behaviors, poor health status, and health disparities. Recent interventions have not demonstrated much success in improving health status or reducing health disparities in the Appalachian region. Since one's perception of personal health precedes his or her health behaviors, the purpose of this project was to evaluate the self-rated health of Appalachian adults in relation to objective health status and current health behaviors.     

病例组合方法及应用探讨

为了保证卫生资源分配的有效性和公平性,我国社会医疗保险制度中有必要引入病例组合(Casemix)的管理模式,病例组合是迄今为止国际上较为理想的卫生资源管理及疾病组合模式,病例组合的实施还能够帮助卫生管理机构建立医疗服务质量的评判标准及医疗机构和个人医疗服务质量与效率的比较标准,从而促进医疗服务质量与效率以及我国公共卫生管理水平的全面提高。     

National health care reform and the 103rd Congress: the activities and influence of public health advocates.

OBJECTIVES: This study examined the activities and influence of public health interest groups and coalitions on the national health care reform debates in the 103rd Congress. METHODS: Congressional staff and representatives of public health interest groups, coalitions, and government health agencies were interviewed. Content analysis of eight leading national health care reform bills was performed. RESULTS: The public health community coalesced around public health in health care reform; nearly all the major interest groups and government health agencies joined two or more public health or prevention coalitions, and half joined three or more. The most effective influence on health care reform legislation was early, sustained personal contact with Congress members and their staffs, accompanied by succinct written materials summarizing key points. Media campaigns and grassroots mobilization were less effective. Seven of the eight leading health care reform bills included one or more of the priorities supported by public health advocates. CONCLUSIONS: The public health community played an important role in increasing awareness and support for public health programs in the health care reform bills of the 103rd Congress.     

Mini-symposium — Public Health Observatories: Building public health skills and capacity in the English regions

Local public health departments have variable access to a public health intelligence function, and information skills are scarce. Public health observatories are supporting the development of professional standards for public health intelligence specialists and offer training opportunities for both defined public health specialists and generalist public health specialists. In addition observatories support public health practice through educational programmes in health impact assessment, health equity audit, public health intelligence, and the provision of toolkits and advice on methods. Observatories have a key role in supporting and developing networks, in particular public health analysts, and the use of interoperable websites is enhancing these opportunities.     

Levels of health development: a new tool for comparative research and policy formulation

Levels of health development are formed by mathematically clustering countries using six health status indicators: crude birth, crude death, infant mortality and child death rates, and male and female life expectancy. Stratifying two international samples of 128 and 163 countries into levels of health development--groups with similar health status profiles--improves the results of regression analyses used to identify economic, political, social, educational, health and other health determinants. For this reason, health development levels are a systematic framework for delineation of health determinants. Earlier large scale statistical studies have been limited in their success in part because they did not partition their data sets prior to analysis, or used inappropriate criteria that blurred rather than heightened developmental differences in underlying social systems. These developmental differences regulate the way in which health status inputs are converted into health status outputs, defining the relative importance of health determinants at various developmental levels. At lowest health development levels (countries with poorer health status), the under-development of economic, health and educational infrastructures creates a vacuum which allows international intervention (aid, investment, export/import activities) to play a dominant role in health status determination. At middle health development levels, health and educational infrastructures are better developed, but still secondary in importance as health status determinants to basic economic infrastructure. Demographic problems are particularly apparent at these levels. At higher health development levels, education, women's status, and political structure are especially important health status determinants. This research has facilitated the identification of health status determinants for use in health policy analysis. Recommendations for future research include use of findings in health policymaking by individual countries and by comparative researchers, and development of appropriate health systems models for each level of health development.     

军队基层健康教育现状调查

目的掌握军队基层健康教育实施情况及官兵健康知识、态度、行为现状,为有针对性的指导部队健康教育和健康促进工作提供依据。方法采用多阶段整群抽样方法,从军队各军区、各军兵种抽取56个基层部队的4263名官兵,用自行设计的“全军健康教育调查问卷”对其所在单位的健康教育实施及个人健康知识、态度、行为情况进行调查。结果分别有80．49％、69．30％、69．99％、54．36％和22．80％的人依次接受了2小时以上新兵健康教育课、2小时以上的继续健康教育课、住院病员健康教育、2小时以上的军校健康教育课和专题健康教育课;官兵健康知识总知晓率为76．70％,健康态度正确持有率为90．35％;健康行为持有率为60．57％;兵龄、职别、兵源地和学历是影响部队官兵健康知识知晓率的因素。结论军队基层健康教育在健康知识的传播方面成效显著,专题健康教育、康复健康教育、继续健康教育时间保证不足。