政策工具视角下我国省级基本公共卫生服务补助资金管理政策分析*

目的：全面分析我国省级基本公共卫生补助资金管理政策现状,并针对可能存在的问题提出相应的政策建议, 以期为优化补助资金管理提供科学参考。方法：采用质性研究的开放式编码方法对我国省级出台的24份基本公共卫生补助资金管理政策进行编码,并基于供给型、需求型和环境型政策工具分析框架进行量化分析。结果：省级基本公共卫生补助资金管理政策在发文时间和地区分布上存在差异,部分省份的政策文本未及时更新,政策工具的运用呈现偏环境型、轻需求型特点。结论：各省份应因地制宜和与时俱进地制定资金管理政策不断优化政策工具的运用比例,积极构建统筹化、精细化和可持续性的资金管理策略。     

New directions in European public health research: report of a workshop

Public health draws from a range of academic disciplines, social, medical and statistical, and answers questions relevant to improving the health of populations. We have initiated a Europe-wide study, Strengthening Public Health Research in Europe, to assess the development and use of public health research in both public policy and local decision making. The contemporary challenge for public health research is to integrate the capabilities of different academic disciplines to address policies for health. We have considered the development of public health research in five fields: political epidemiology, community health, health services, economics, and evaluation evidence and synthesis. The organisation and funding of research in Europe should be able to support new research fields and issues, to contribute to policy development and public health practice.     

我国卫生政策与体系研究科研项目及经费现状分析

目的：描述我国卫生政策与体系研究领域科研项目及经费现状,分析存在的问题,为促进研究能力提高提供建议。方法：通过问卷调查和关键人物深度访谈,从科研项目数量及分布、主题情况等方面进行分析。通过公开资料梳理,从项目数量与分布、主题情况等方面对国家自然科学基金的资助情况进行分析。结果：2015—2017年平均每个机构每年开展科研项目26.25项,涉及主题为卫生筹资、服务提供、卫生人力等;平均每个机构每年的科研经费为529.00万元;63.16%的研究机构来自国内的经费资助多于来自国际的经费资助,政府来源经费占全部经费比例为44.23%;财务管理方面,科研经费通常由上一级机构的财务管理部门通过预决算机制进行管理。2008—2017年,共有116家机构获得国家自然科学基金资助,平均每个机构获得项目数为4.81项、所获得资助金额为169.06万元,主要研究为卫生服务提供相关主题。结论：我国卫生政策与体系研究科研项目数量及经费快速增长,但主要集中于发达地区的研究机构,存在地区不平衡现象;国际资助呈现下降趋势,国内来源占比越来越高;经费管理机制在逐步调整,但不同机构落实方面存在差异。     

Funding formulas for public health allocations: federal and state strategies

Public health funding formulas have received less scrutiny than those used in other government sectors, particularly health services and public health insurance. We surveyed states about their use of funding formulas for specific public health activities; sources of funding; formula attributes; formula development; and assessments of political and policy considerations. Results show that the use of funding formulas is positively correlated with the number of local health departments and with the percentage of public health funding provided by the federal government. States use a variety of allocative strategies but most commonly employ a "base-plus" distribution. Resulting distributions are more disproportionate than per capita or per-person-in-poverty allotments, an effect that increases as the proportion of total funding dedicated to equal minimum allotments increases.     

Financing global mental health services and the role of WHO

A concrete indicator of a government's commitment to mental health services is the amount of financial resources it allocates. To encourage the government to increase mental health funding, it would require additional research and dissemination findings on the economic consequences of mental health disorders, cost-effectiveness benefits of alternatives treatment, and alternative methods of financing for mental health illnesses. In addition, an organized consumer group can be an effective means in informing legislative and government policy makers. Public financing alone is not sufficient for treating mental illness. Private financing may supplement public funding. It would be important to combine both public and private funding to deliver adequate services for mental illness patients. WHO has been very effective in global tobacco control and SARS epidemic. The new administration should use this successful momentum to initiate a global funding campaign for mental health disorder as a top priority.     

Evolution of primary care in China 1997-2009

Primary health care, once the cornerstone of China's health system, has been neglected in the country's market-oriented system. Recent primary care reform was designed to improve access, quality and efficiency of health service use, but the results are unclear. The government is dramatically increasing funding for community health services, but there is concern about maximizing the impact of this investment. This paper draws on policy analysis, literature review, and a secondary analysis of two case studies and two surveys to review the structure of community health services and public reaction to them. Our results suggest that despite several years of primary care reform, current performance remains poor. The capacity of providers is low, services are not felt to be affordable, and patients report concerns about safety, all contributing to low utilization of community health facilities. We argue that the minimum skill set for community health service providers should be clearly defined to focus training efforts as should the role of community health facilities within the health system. Moreover, a quality and accountability framework for community health service is needed so that increased funding can produce a strong foundation for China's health system.     

What are the respective roles of the public and private sectors in pharmaceutical innovation?

What are the respective roles of the public and private sectors in drug development? This question is at the heart of some policy proposals, such as those that would give the government a share of profits from drugs at least partly developed with federal research dollars. This paper provides empirical data on these issues, using information included in the patents on drugs approved between 1988 and 2005. Overall, we find that direct government funding is more important in the development of "priority-review" drugs-sometimes described as the most innovative new drugs-than it is for "standard-review" drugs. Government funding has played an indirect role-for example, by funding basic underlying research that is built on in the drug discovery process-in almost half of the drugs approved and in almost two-thirds of priority-review drugs. Our analyses should help inform thinking about the returns on public research funding-a topic of long-standing interest to economists, policy makers, and health advocates.     

A Program Evaluation of a Dietary Sodium Reduction Research Consortium of Five Low- and Middle-Income Countries in Latin America

Excess dietary sodium is a global public health priority, particularly in low- and middle-income countries where rates of hypertension and cardiovascular disease are high. The International Development Research Centre funded a research consortium of five Latin American countries (LAC) to inform public health policy for dietary sodium reduction (2016–2020). The objective of this study was to determine the outcomes of this funding on short-term (e.g., research, capacity building) and intermediary outcomes (e.g., policies). A summative program evaluation was conducted, using a logic model and multiple data sources including document review, surveys and interviews. Researchers from Argentina, Costa Rica, Brazil, Peru and Paraguay produced a significant amount of scientific evidence to guide decision making on sodium policy related to its content in foods, consumer behaviors (social marketing), and the health and economic benefits of dietary reduction. A substantive number of knowledge translation products were produced. The funding enabled training opportunities for researchers who developed skills that can be scaled-up to other critical nutrients and health issues. It was unexpected that intermediary policy changes would occur, however several countries demonstrated early policy improvements derived from this research. A funded research consortium of LAC is a practical approach to invoke policy innovations.     

医疗机构产权制度改革探讨

探讨医疗机构产权制度的形成;医疗机构产权制度改革的动因;医疗机构产权制度改革的主要形式,以及医疗机构产权制度改革的评价,认为医院改制既有积极效应,又有待解决的问题.     

Nongovernment Philanthropic Spending on Public Health in the United States

The objective of this study was to estimate the dollar amount of nongovernment philanthropic spending on public health activities in the United States.Health expenditure data were derived from the US National Health Expenditures Accounts and the US Census Bureau.Results reveal that spending on public health is not disaggregated from health spending in general. The level of philanthropic spending is estimated as, on average, 7% of overall health spending, or about $150 billion annually according to National Health Expenditures Accounts data tables. When a point estimate of charity care provided by hospitals and office-based physicians is added, the value of nongovernment philanthropic expenditures reaches approximately $203 billion, or about 10% of all health spending annually.The role of nongovernment philanthropic organizations in supporting public health is widely recognized, but there is doubt about their level of contribution. None of the surveys or data abstractions to date provide estimates of the level of philanthropic spending on public health.Each year, the Centers for Medicare and Medicaid Services’ National Health Expenditures Accounts (NHEA) produce overall estimates of dollar amounts for all health care consumed in the United States. These estimates, available through the NHEA since 1960, are a valuable resource for assessing trends in health care spending on public health, health care goods and services, government administration, health insurance, and other investments related to health care.1–4The role of government in public health is obvious because federal, state, and local governments bear prime responsibility for the public health enterprise: prevention, surveillance, and response to emergencies for the health of all. As noted by the Institute of Medicine, nongovernmental organizations (NGOs), individuals, and private-sector entities play a supporting role:

Agencies that have made progress building mission-critical capacities appear to use a wide variety of funding sources to support these investments, including flexible funds from local government, flexible funds from state government, cross-subsidization from reimbursement- and fee-based services, categorical program funds, and private-sector grants from philanthropic organizations, health system partners, and corporate foundations.5^(p184)

One example of the significance of private-sector funding is the Turning Point Initiative sponsored by the W.K. Kellogg Foundation and the Robert Wood Johnson Foundation, which has supported state and local public health agencies in their capacity-building efforts. Another example is the Robert Wood Johnson Foundation’s Multi-State Learning Collaborative, which has contributed to capacity improvements among state public health agencies.Nongovernment philanthropic entities also provide new direction and creative approaches to emerging public health concerns when the government sector cannot quickly tackle these issues, as was the case with the support provided by NGOs to expand the capacity of public health laboratories. As another example, the CDC Foundation benefits from the contributions of NGOs to expand the prevention and disease surveillance efforts of the Centers for Disease Control and Prevention. As noted, however, as of yet none of the surveys or data abstractions of the NHEA, the US Census Bureau, or the Giving USA Foundation (which produces The Annual Report on Philanthropy) have provided estimates of the level of philanthropic spending on public health.There is uncertainty about levels of public health investments made by philanthropies because of lack of data:

The combination of [the] historical circumstance in funding, a lack of national standards in recording and reporting funding and expenditure data, and variations in the definitions of public health challenges any attempt to obtain accurate expenditure estimates.5^(p76)

Well-known philanthropic organizations such as the Robert Wood Johnson Foundation, the Kaiser Family Foundation, and the W.K. Kellogg Foundation have a frontline presence in their work with federal government agencies and local health departments. These foundations are engaged in activities such as public health preparedness, immunization programs at the local level, and workplace wellness programs. The Grantmakers in Health nonprofit organization lists 240 organizations that are active in the areas of health and public health. However, data on these nongovernment public health activities and spending are not as organized as those of the government sector.My goal here is to use available data on public health spending to answer a basic research question: what are the precise or approximate estimates of the dollar contributions of nongovernment philanthropies to public health? I discuss the data available from the NHEA and the Census Bureau.     

Health impact assessment of agriculture and food policies: lessons learnt from the Republic of Slovenia

The most important public health priority in agricultural policy-making is currently food safety, despite the relatively higher importance of food security, nutrition, and other agricultural-related health issues in terms of global burden of disease. There is limited experience worldwide of using health impact assessment (HIA) during the development of agriculture and food policies, which perhaps reflects the complex nature of this policy sector. This paper presents methods of HIA used in the Republic of Slovenia, which is conducting a HIA of proposed agricultural and food policies due to its accession to the European Union. It is the first time that any government has attempted to assess the health effects of agricultural policy at a national level. The HIA has basically followed a six-stage process: policy analysis; rapid appraisal workshops with stakeholders from a range of backgrounds; review of research evidence relevant to the agricultural policy; analysis of Slovenian data for key health-related indicators; a report on the findings to a key cross-government group; and evaluation. The experience in Slovenia shows that the HIA process has been a useful mechanism for raising broader public health issues on the agricultural policy agenda, and it has already had positive results for policy formation. HIA is one useful approach to more integrated policy-making across sectors, but clearly it is not the only mechanism to achieve this. A comparison of the approach used in Slovenia with HIA methods in other countries and policy contexts shows that there are still many limitations with HIA application at a government level. Lessons can be learnt from these case studies for future development and application of HIA that is more relevant to policy-makers, and assists them in making more healthy policy choices.     

江苏省农村公共卫生投入现状及对策研究

目的以江苏省农村公共卫生投入现状为依据,对其收支经费分析．找出政府在公共卫生经费投入与补偿方面存在的主要问题,并提出相应的对策。方法理论文献研究法、描述性统计分析法。结果在三类地区,无论是市（县）级疾病控制机构还是妇幼保健机构,均存在以下几个问题：一是政府对卫生支出的绝对数在增加,但占财政支出比重呈下降趋势：二是政府对公共卫生机构的投入主要集中在高层次机构;三是政府对这些机构的投入不足,不能保证基本人员经费支出：四是经费主要来源于有偿服务收入,补偿机制不健全。结论针对存在的问题,提出相应对策：（1）明确政府补偿责任．加大政府投入．确保基本公共卫生服务提供;（2）政府公共卫生投入要向基层倾斜,提高农村公共卫生机构经费投入中政府财政投入比重：（3）实现政府补偿形式的多样化,健全公共卫生经费投入机制;（4）改变预算机制,实行按任务预算的公共卫生服务购买机制．提高公共卫生机构的效率．     

直接举办还是购买卫生服务：相关理论与政策问题探讨

政府购买卫生服务还是政府举办医疗机构直接提供卫生服务,这是学术界和政策制定者关注和争论的焦点问题之一。本文从这两项政策的具体内涵入手，比较两种干预方式的具体形式、理论基础和实践经验，分析购买卫生服务中必须解决的为谁购买、购买什么、从何处购买、如何购买、以何种价格购买以及谁是购买者等基本问题，并根据现阶段我国医疗卫生市场的发展状况进行政策取舍，得出了基本结论：二者都是政府实现卫生责任的方式，具有不同的适用范围和条件；当前应以政府直接举办医疗机构为主要形式，当务之急是完善卫生经费的拨款方式，加强绩效考核，提高资金的使用效率。     

我国高校卫生政策与体系研究现状及人才教育培养重点分析

目的:描述我国高校卫生政策与体系研究(Health Policy and Systems Research,HPSR)现状及能力发展面临的问题与挑战,并提出人才教育培养方面的建议。方法:对我国8所具有代表性的高校中从事HPSR的人员进行定量调查和定性访谈。结果:我国高校从事HPSR的科研人员较为年轻,75.26%具有博士学位,以卫生管理和公共卫生学科背景为主。在研项目分析显示,卫生信息与证据是该领域的主要研究方向,资金投入量和研究者关注度均较高。然而,当前研究资源仍较集中于资深研究者,对青年学者支持力度有限。HPSR以跨领域多学科为特征,但目前机构及个人间的合作较为有限。此外,高校承担的研究项目中仅5.81%转化为政策。讨论与建议:鉴于我国高校HPSR能力方面面临研究者较为缺乏且背景单一、多学科合作受限、HPSR科研投入不足、青年研究者所获资源有限、政策转化能力薄弱等问题。建议在进行高校HPSR人才教育培养过程中,加强本科生和研究生的教学,加强对青年研究者的培训和支持,建立研究成果传播与转化机制。     

Working for the public health: politics,localism and epistemologies of practice

The recent move of public health back to English local government has reignited debates about the role of a medicalised public health profession. The explicit policy rationale for the move was that local government is the arena in which the social determinants of health can be addressed, and that public health specialists could provide neutral evidence to support action on these. However, if a discourse of ‘evidence‐based’ policy is in principle (if not practice) relatively unproblematic within the health arena, within the more overtly politicised local government space, rather different policy imperatives come to the fore. Responding to calls for research on evidence in practice, this article draws on ethnographic data of local authorities in the first year of the reorganised public health function. Focusing on alcohol policy, we explore how decisions that affect public health are rationalised and enacted through discourses of localism, empiricism and holism. These frame policy outcomes as inevitably plural and contingent: a framing which sits uneasily with normative discourses of evidence‐based policy. We argue that locating public health in local government necessitates a refocusing of how evidence for public health is conceptualised, to incorporate multiple, and political, understandings of health and wellbeing.     

我国农村公共卫生资源配置现状与对策探讨

分析了我国大陆农村公共卫生资源配置存在的经费投入不足、机构设置未达到全覆盖、现有人力资源难以满足需要、资源配置结构性失调等问题,提出制定引导公共卫生资源向农村流动的相关政策、强化政府公共财政投入责任、加强农村公共卫生机构建设、提升公共卫生人力资源素质、调整农村公共卫生资源配置结构、推进乡村一体化管理等对策,为提高农村公共卫生服务水平、推动基本公共卫生服务城乡均等化进程提供参考。     

Establishing and sustaining research partnerships in Africa: a case study of the UK-Africa Academic Partnership on Chronic Disease

ABSTRACT: This paper examines the challenges and opportunities in establishing and sustaining north-south research partnerships in Africa through a case study of the UK-Africa Academic Partnership on Chronic Disease. Established in 2006 with seed funding from the British Academy, the partnership aimed to bring together multidisciplinary chronic disease researchers based in the UK and Africa to collaborate on research, inform policymaking, train and support postgraduates and create a platform for research dissemination. We review the partnership's achievements and challenges, applying established criteria for developing successful partnerships. During the funded period we achieved major success in creating a platform for research dissemination through international meetings and publications. Other goals, such as engaging in collaborative research and training postgraduates, were not as successfully realised. Enabling factors included trust and respect between core working group members, a shared commitment to achieving partnership goals, and the collective ability to develop creative strategies to overcome funding challenges. Barriers included limited funding, administrative support, and framework for monitoring and evaluating some goals. Chronic disease research partnerships in low-income regions operate within health research, practice, funding and policy environments that prioritise infectious diseases and other pressing public health and developmental challenges. Their long-term sustainability will therefore depend on integrated funding systems that provide a crucial capacity building bridge. Beyond the specific challenges of chronic disease research, we identify social capital, measurable goals, administrative support, creativity and innovation and funding as five key ingredients that are essential for sustaining research partnerships.     

Western organizational change capacity theory and its application to public health organizations in China: A multiple case analysis

As health reform becomes a crucial task for both Chinese and United States government, public health organizations are required to adopt changes based on reform policy. Organizational Change Capacity theory is a Western theory that indicates the capacities that organizations should possess when pursuing successful organizational change. This study seeks to understand the applicability of this theory to Chinese public health organizations by contrasting organizations that have achieved success or remained challenged in implementing organizational change to optimize health reform. The research questions are: Is the Organizational Change Capacity theory applicable in Chinese public health organizations? How should it be modified to best fit Chinese public health organizations? Seventy‐two participants from 12 public health organizations in Beijing and Xi'an were recruited for interviews and follow‐up questionnaires that asked for experiences during their organizational changes. During the analysis, a new Chinese Organizational Change Capacity theory with nine main themes emerged. This new framework provides a guideline for Chinese public health organizations to evaluate their change capacity, and offers a theoretical foundation for researchers to design interventions that increase these organizations' capacity in achieving successful change.     

Outcomes from NHMRC public health research project grants awarded in 1993

AIMS: In 1987, the Public Health Research and Development Committee (PHRDC) was established by the NHMRC as one mechanism to fund public health research in Australia. In 1993, it awarded 32 new and 31 continuing project grants. Given increasing interest in research accountability in Australia, we designed an audit to determine outcomes from this investment. We also explored grant recipients' views about sources of research funding and strategies to enhance research dissemination. METHOD: Self-administered survey, July 1999. MAIN RESULTS: We obtained a 69% response fraction. The majority of projects already had been completed with peer-reviewed articles the most common outputs. More than half (58%) of respondents 'strongly agreed' or 'agreed' that their research had influenced policy to improve public health and 69% that it had influenced practice. Study design was significantly associated with peer-reviewed output, whether self-reported (p=0.002) or corroborated by us (p=0.004). With respect to research funding, significantly more agreed that the NHMRC should enhance program grants for public health research than mechanisms through the Strategic Research Development Committee (p=0.013). The most highly rated strategy to enhance dissemination was greater demand for research results among policy makers. CONCLUSION: A pleasing proportion of projects funded by PHRDC in 1993 generated peer-reviewed publications and provided research training. Recipients perceive their research has influenced policy and practice. Recipients' views about strategies to increase funding for public health research are consistent with current reforms within the NHMRC. Policy makers emerge as a key target for training in research transfer.