加入WTO公共卫生面临的挑战

1995年1月世界贸易组织(WTO)成立以来,全球化速度明显加快,全球化、实施WTO协定及其对公共卫生和健康的影响越来越受到广泛的关注.     

《现代预防医学》杂志2003年载文分析

随着我国现代化的进程，尤其是市场经济体系的建立、发展和不断完善、科技水平的提高以及卫生改革的深入。同其它各个领域一样，预防医学与公共卫生事业的发展获得了许多发展的良机，特别是进入21世纪和加入WTO后。给我国公共卫生事业发展带来了更多的发展机遇。同时也面临许多新的挑战。研究和制定与之相适应的对策，对推动我国公共卫生事业的发展具有十分重要的意义。《现代预防医学》杂志自1975年创刊以来，     

加入WTO对我国公共卫生与疾病预防控制挑战及应对策略探讨

我国于 2 0 0 1年 1 1月正式成为世界贸易组织 (WTO)的成员 ,这是我国改革开放进程中具有历史意义的一件大事 ,也是进一步推进我国全方位、多层次对外开放的重要契机 ,对我国经济发展和社会进步具有深远的影响。卫生事业是我国经济和社会发展中的重要组成部分。面对入世的新形势 ,认真学习并熟悉掌握 WTO的基本原则和有关规则 ,分析入世对我国公共卫生与疾病预防控制的影响 ,是十分重要的。本文就这个问题及应对策略作初步分析与探讨。1　我国公共卫生与疾病控制工作的主要成就目前 ,我国居民的平均期望寿命为 71 .8岁 ;婴儿死亡率3 3 .2…     

四川省疫青和突发公共卫生事件网络直报工作现状分析

众所周知,经历了SARS暴发后,我国在发展公共卫生事业,健全公共卫生体系方面已成为全社会关注的焦点.党和国家领导人对公共卫生事业发展也给予了前所未有的重视.在这样的大背景下,我国于2004-01-01全面启动了"传染病疫情和突发公共卫生事件监测信息报告系统",标志着我国公共卫生事业发展迈上了一个新的台阶.在四川省卫生厅及相关领导的大力支持下,通过全省21个市(州),183个县(区)相关部门许多同志的共同努力,克服重重困难,按照国家要求完成了"疫情和突发公共卫生事件信息系统"的建设.目前,正积极稳妥地推进四川省网络直报工作的深入和不断完善.现将该项工作现况作如下分析.     

抓住机遇 迎接挑战——加入WTO我国肉类食品业面临的新形势

近一时期以来,我国加入世界贸易组织(以下简称WTO)的谈判取得重大进展,引起我国各界人士的关注。加入WTO是我国改革开放过程中的一件大事,对我国经济在21世纪     

加强新闻舆论宣传——我国公共卫生的一项战略选择

<正>1 我国公共卫生缺乏良好的社会舆论氛围 20世纪,新中国的公共卫生事业取得了举世瞩目的成就。然而,在世纪更替,社会主义市场经济体制正加快建立的重要时期,我国公共卫生却遇到了许多过去没有遇到的新问题,“面临着前所未有的严峻挑战”[1]。而“缺乏舆论”[2],没有形成良好的社会舆论扭转是其中的一个十分突出的问题。主要表现在以下几个方面:     

加入 WTO后对我国卫生事业的战略思考

我国已正式加入世界贸易组织(WTO),这标志着我国对外开放进入了一个新的阶段。认真分析加入WTO对我国卫生事业的影响,审时度势,制定对策,才能促进卫生事业的健康发展。     

试论当前我国卫生投入的合理取向

自2003年下半年以来，我国许多地区投入巨资用于发展卫生事业的消息不断见诸报端。其投入方向也不尽相同，有以建设公共卫生设施为主，有以增强疾病预防控制能力、提升突发公共卫生事件应急整体水平为主，也有以打造医疗“航空母舰”，着力建设现代化医院，以适应大型、特大型城市发展的需要，适应加入WTO后医疗市场的激烈竞争。那么，究竟应当如何看待当前我国卫生投入的不同取向?换言之，     

加入WTO后对我国医疗保障体系的影响及应对策略

世界贸易组织(WTO)对推动全球经济发展起着极其重要的作用，根据WTO《服务易总协定》的条款，加入WTO后，我国医疗卫生行业将全面向国际市场开放。该就目前我国医疗保障体系的现状、加入WTO对我国医疗保障体系的影响进行了分析，并研究了应采取的对策和建议。     

我国农村和城市公共卫生发展不平衡分析

目前，我国公共卫生事业发展存在的一个突出问题是卫生体系发展极不平衡，特别是城市和农村公共卫生发展不平衡已经严重影响了我国公共卫生事业的整体发展。     

Getting the most from an independent review organization

Providing high-quality care while keeping health care costs under control is not the responsibility of just one group. It is a collaborative effort involving interorganizational cooperation. In the arena of case management (CM), that effort is shared by the insurance provider, the patient' physician, the case manager, and often by an independent review organization (IRO).     

Escaping from the dual organization: physician self-governance.

This article discusses a way of coping, in a time of limited resources, with the dual organization problem in hospitals. First, the historical roots of the dual organization problem are analysed. It is ascertained that the power structure within the hospital crucially depends on the socioeconomic circumstances and the state of medical knowledge. Since the health care systems of most industrialized countries are in transition from a stage of rapid expansion into a stage of consolidation, new problems arise which cannot be adequately handled within the context of the dual organization structure. The crux of the dual organization problem lies in the separation of the related responsibilities for resource allocation and patient care. Most proposals to solve this problem try to develop models of shared authority, which may be elegant in theory but often raise tremendous problems when implemented in practice. A straightforward solution would be the reunion of both responsibilities under one head, the physician-executive. It is argued that in a situation of limited funds for medical care, patients, physicians as well as administrators will be best off when physicians become primarily responsible for the resource allocation within the hospital. Some empirical evidence for this supposition is discussed. Finally, attention is paid to the prerequisites for, and implementation of, physician self-governance.     

公立医疗机构“管办分离”之我见

从公共管理的角度,运用公共管理的相关理论,论述了医疗卫生服务的公益性与公立医疗机构的公益性、医疗卫生服务的生产与提供的区别,提出了公立医疗机构"管办分离"的理论依据和现实意义,希冀对澄清某些模糊认识有所帮助.     

Work organization and atherosclerosis: Findings from the ARIC study

Introduction: The aim of this investigation was to examine the extent to which work organization (i.e., occupational stress) is associated with subclinical carotid atherosclerosis.Methods: For that purpose we used a cross-sectional study of four U.S. community samples conducted between 1987 and 1989. Participants in the study were 10,801 adults aged 45 to 64 years. Subclinical carotid atherosclerosis was assessed by measuring the intima-media thickness (IMT) of the carotid artery wall using B-mode ultrasound. Occupational stress was defined using six indicators: substantive complexity of work, physical demands, job insecurity, skill discretion, decision authority, and physical exertion. Information from U.S. national surveys on occupational stress indicators was linked to the study participants' occupation.Results: We observed negative associations of complexity of work and skill discretion with mean IMT of the carotid artery wall among the four race-gender groups. In addition, physical demands was positively associated with mean IMT among blacks and job insecurity was positively associated with IMT among white women and black men. After adjustment for well-established risk factors, the magnitude of these associations was substantially reduced.Conclusions: Taken in combination with results from recent European studies, our findings suggest that work organization plays a role in the etiology of atherosclerosis.     

Promoting quality: the health-care organization from a management perspective.

BACKGROUND: Although agreement about the need for quality improvement in health care is almost universal, the means of achieving effective improvement in overall care is not well understood. Avedis Donabedian developed the structure-process-outcome framework in which to think about quality-improvement efforts. ISSUE: There is now a robust evidence-base in the quality-improvement literature on process and outcomes, but structure has received considerably less attention. The health-care field would benefit from expanding the current interpretation of structure to include broader perspectives on organizational attributes as primary determinants of process change and quality improvement. SOLUTIONS: We highlight and discuss the following key elements of organizational attributes from a management perspective: (i) executive management, including senior leadership and board responsibilities (ii) culture, (iii) organizational design, (iv) incentive structures and (v) information management and technology. We discuss the relevant contributions from the business and medical literature for each element, and provide this framework as a roadmap for future research in an effort to develop the optimal definition of 'structure' for transforming quality-improvement initiatives.     

Increasingly distant from life: problem setting in the organization of home care

Abstract The analysis undertaken in this paper explores the significance of a central finding from a recent field study of home care case management practice: a notable feature of case management work is the preparation of an orderly, ordered space where care may be offered. However, out of their encounters with an almost endless variety of situations, out of people's diverse narratives of need, case managers seem able to pick out only limited range of recognized needs to which to respond and demonstrate a series of responses themselves equally limited. Though this observation suggests a kind of efficiency that is currently highly valued within healthcare systems, it also underlines the system's inability to engage difference and variability in a meaningful way. This inability or limitation in effectively engaging difference is conceptualized here as, in some sense, a problem, and the nature of this problem is explored through the rhetorical process of problem setting. The central question becomes how might we develop and deploy an orderly and coherent system of care without essentializing people's experiences, without treating these experiences reductively, without, in a Foucaultian frame of reference, allowing what can be understood as similarity or resemblance among clients and situations to be folded back into sameness? As we encounter complexity, variability and difference in practice, how should we treat it?     

Reflections from organization science on the development of primary health care research networks

In the UK, policy changes in primary health care research and development have led to the establishment of primary care research networks. These organizations aim to increase research culture, capacity and evidence base in primary care. As publicly funded bodies, these networks need to be accountable. Organizational science has studied network organizations including why and how they develop and how they function most effectively. This paper draws on organizational science to reflect on why primary care research networks appear to be appropriate for primary care research and how their structures and processes can best enable the achievement of their aims.