上海市卫生改革与发展情况综述

2003年3月10日上海市召开了卫生工作会议。上海市委副书记殷一璀同志就上海卫生改革与发展提出三点要求：一是以促进人的全面发展为核心，坚持发展是第一要务的理念，构建上海医疗卫生事业的新格局；二是以改革为动力，加快上海卫生事业的新发展。卫生系统要推进“三项改革”，即：卫生管理体制改革、卫生投融资体制改革和医院内部管理改革。     

农村区域卫生资源纵向整合的实践与思考

区域卫生资源纵向整合,是进一步优化卫生资源配置,强化社区卫生服务功能,逐步实现基本医疗服务重心不沉社区,解决当前特别是农村老百姓“看病贵、看病难”问题的一种有益探索。本文就上海郊区——奉贤区三年来开展农村区域卫生资源纵向整合的具体做法及取得的成效和存在的有关问题进行探讨,并对进一步深化此项工作提出建议。     

上海市卫生局党委书记、局长刘俊谈上海未来卫生体系建设

关于到2000年要初步建立具有中国特色、上海特点的卫生体系，我们已形成初步思路：一是建设卫生服务体系。对一、二、三级医院进行功能定位，市、区县分别制定区域卫生规划，加强医疗机构监督管理，从宏观上调控、优化卫生资源配置，提高卫生资源效益，同时加快发展社区卫生服务。二是建设预防保健体系。要在巩固急性传染病防治成果的基础上，筹建疾病控制中心，以适应疾病谱的改变，承担起包括预防控制慢性非传染性疾病在内的卫生防病任务。三是建立卫生执法体系。公共卫生、药品、医疗机构监督三大执法条线组建机构，形成网络，严格监督，…     

社区流动人口基本卫生服务模式的研讨

随着改革开放的深入和上海经济建设的迅速发展，以外来劳动力为主体的流动人口以前所未有的速度增长。目前上海有流动人口３００万左右，徐汇区有流动人口１０万以上。流动人口的大量流入，给上海的卫生管理带来了一些问题，增加了社区居民的患病风险。积极探讨上海流动人口卫生服务模式，为流动人口提供基本卫生服务，是发展城市社区卫生服务的重要任务。一、流动人口的卫生状况本院对所管辖的部分用工单位、建筑工地、散居的５６４名流动人口作抽样调查，结果表明流动人口具有以下特点：１．流动人口以中青年为主，文化程度低　流动人口年…     

蔡仁华同志谈“两江”试点

蔡仁华同志谈“两江”试点据《上海卫生》报道，卫生部政策法规司司长蔡仁华同志在１９９５年１１月召开的华东地区卫生厅局长会议上讲话指出，＂两江＂试，点有比较突出的成效。一是群众基本医疗得到保障。二是抑制了医疗费用过快增长的势头。三是推动了医院业务管理机制...     

提高细菌性腹泻病原检验的若干问题

提高细菌性腹泻病原检验的若干问题本刊就当前细菌性腹泻病原菌检测工作一所存在的一些问题，邀请了上海守卫生防疫站细菌检验科主任、主任技师陆广珍，科副主任居建华，副主任技师陈长怡、张鸿富以及虹口区、卢湾区卫生防疫站细菌检验科主任潘亚光、胡君生，金山县卫生防...     

突出重点 强化措施 加大力度 卫生改革发展思路与举措(二)

上海 上海市委、市政府要求各级党委和政府一定要高度重视,加强领导,把卫生工作纳入经济和社会发展的总体规划,及时解决好卫生事业改革和发展过程中的重点、难点问题,形成全社会参与卫生事业的工作格局,卫生工作要努力实现三个重大转变。 一是卫生资源配置要从扩大规模发展外延,向注重内涵、提高效益转变; 二是卫生发展重点要从医疗为主向医疗预防保健     

上海卫生科技发展回顾与未来发展变革的思考

阐述上海卫生科技目前存在的优势和面临的挑战,分析上海卫生科技发展需解决的问题,探讨发展上海卫生科技发展的策略,为加速上海卫生科技发展提供建议。     

对卫生经济规律问题的几点思考

“看病贵、看病难、看病烦”既是老百姓对医疗反映最强烈的问题，也是医疗系统本身历史积累深层次矛盾和向市场经济转轨过程中新出现问题的交互叠加的具体表现。2000年上海“三医”联动改革会议八部委联合出台的一些卫生政策，的确对当时的卫生改革起到了一定的指导与推动作用。但是，5年多过去了，造成“看病贵、看病难、看病烦”的一些深层次的问题仍然存在，体制、机制上还没有根本性突破。医疗问题涉及面广、悠关广大老百姓的切身利益，是个世界性的难题，     

我国医疗卫生体制改革问题与原因的再思考

文章从三方面深入阐述了我国医疗卫生体制改革存在的突出问题，一是医疗卫生服务可及性与公平性问题严重；二是医疗费用急剧上涨，国民总体健康水平改善速度减缓；三是卫生资源短缺与卫生资源浪费并存。并在此基础上论述了产生这些突出问题的主要原因．指出改革思路混乱，政府职责缺失是问题产生的根本原因。     

上海卫生发展的外部环境分析

随着上海经济社会发展的步伐不断加快，上海的卫生事业也要加快创新和发展。该通过对影响上海卫生发展的若干因素进行分析，指出了影响和制约上海卫生发展的主要外部环境要素，从而能使得上海的卫生发展更好地与整个上海社会发展的要求相一致，更好地促进卫生事业的改革和发展。     

Aid coordination for health sector reform: a conceptual framework for analysis and assessment

Recent widespread interest in health sector policy and institutional reform in lower income countries has coincided with heightened concern for aid coordination. Because the health budgets of many low income countries are highly aid dependent, donors are strongly placed to make aid conditional on health care reforms. However, given the growing number and heterogeneity of multilateral, bilateral and international non-governmental donors operating in many of these countries, there is concern that if external efforts are not coordinated, the aims of health care reform--namely improving efficiency, effectiveness and equity--will not be met. Evidence is mounting that without effective coordination arrangements, donors may weaken rather than improve fragile health systems, undermining attempts to reform those systems. This paper traces the factors fuelling current interest in coordination, in particular with reference to its contribution to the goals of health sector reform. Aid coordination is defined and its principles elaborated. A framework is developed by which to assess the variety of coordination mechanisms which are evolving at the county level. In light of this framework, a case is made for greater and more critical analysis of aid coordination arrangements. The paper concludes that if health sector reform is to be successful in low income countries, current enthusiasm for coordination needs to be harnessed. The framework offered here provides a way of assessing the variety of coordination mechanisms currently proliferating, which could be used to enhance health sector reform.     

Health sector reform in the Occupied Palestinian Territories (OPT): targeting the forest or the trees?

Since the signing of the Oslo Peace Accords and the establishment of the Palestinian Authority in 1994, reform activities have targeted various spheres, including the health sector. Several international aid and UN organizations have been involved, as well as local and international non-governmental organizations, with considerable financial and technical investments. Although important achievements have been made, it is not evident that the quality of care has improved or that the most pressing health needs have been addressed, even before the second Palestinian Uprising that began in September 2000. The crisis of the Israeli re-invasion of Palestinian-controlled towns and villages since April 2002 and the attendant collapse of state structures and services have raised the problems to critical levels. This paper attempts to analyze some of the obstacles that have faced reform efforts. In our assessment, those include: ongoing conflict, frail Palestinian quasi-state structures and institutions, multiple and at times inappropriate donor policies and practices in the health sector, and a policy vacuum characterized by the absence of internal Palestinian debate on the type and direction of reform the country needs to take. In the face of all these considerations, it is important that reform efforts be flexible and consider realistically the political and economic contexts of the health system, rather than focus on mere narrow technical, managerial and financial solutions imported from the outside.     

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。     

中国卫生改革的形势:问题和挑战

分析了当前中国卫生改革的形势，认为存在的主要问题是卫生系统绩效差，医院市场化、医疗费用增长、需求受抑制，城乡之间在卫生服务覆盖率、可及性和健康结果等方面的差异拉大。总结了三医联动改革的成就和今后改革的方向，认为中国需要做更多的循证政策研究来解决自身的问题并迎接挑战。     

新医改背景下上海市居民对基层医疗卫生服务满意度的调查研究

目的 了解新医改背景下上海市居民对基层医疗卫生服务的满意度.方法 采用分层抽样方法,选取上海市中心城区、城乡结合区和郊区9家社区卫生服务中心,采用自行设计问卷对2 250名门诊患者就其对基层医疗卫生服务满意度进行测评.结果 居民对新医改的满意率为85.2％;对基本医疗保障制度的满意率为85.0％;对基层医疗服务比较满意,满意率为96.5％;对基本公共卫生服务的满意率为95.1％.年龄、城乡、职业、文化程度和收入是居民对基层医疗卫生服务满意度的主要影响因素.结论 总体而言,上海市居民对基层医疗卫生服务满意度较高,但也存在一些问题值得关注,如基本医疗保险保障水平和报销手续仍有待提高、基层医疗卫生机构的诊疗费用仍需合理控制和基本药物无法完全满足基层医疗机构的用药需要.     

社区卫生服务改革的模式演进与版本升级研究——以上海市长宁区为例

任何改革在基层的实施都需要转换成一系列的制度安排或微观行为激励机制,不仅确保基层行动者之间的行为策略激励相容,还要确保基层行动者的行为模式与改革政策目标方向相一致。从上海市长宁区社区卫生服务改革的实践来看,其大致经过了四个阶段:标准化建设与组织确立、服务模式与机制改革、激励设计与内涵建设、平台打造与效能提升。长宁医改在不断深化政策试验与制度创新的过程中逐步化解新医改政策实施过程所产生的各类新问题及其与环境的相容性问题,以实现医改政策的制度化并为利益相关者的福利改进提供稳定的行为预期,从而不断降低基层行动者对政策实施的潜在抵制行为,逐步地将各类行动者的行为激励引导到与政策目标相一致的方向。     

上海新一轮区域卫生规划的特点和实施探讨

在研读《上海市区域卫生规划（2011-2020年）》和分析上海近年卫生发展状况及挑战的基础上,指出上海新一轮区域卫生规划在目标的设定上遵循需求导向和问题导向,在任务和指标设计上统筹考虑了立足上海和服务全国、＂立地＂和＂顶天＂、硬件和软件、当前需求和未来发展,以及具有分级规划和可落地性等特点,并建议规划的实施要注重工作机制的建立、改革的配套和发挥社会力量的作用等。     

"总量控制、结构调整"政策的循证分析

上海市是在医疗费用迅猛增长的背景下出台“总量控制、结构调整”政策的。总控的实施确实控制了医疗费用的快速增长，并给整个卫生体系带来了一定的益处，但在政策实施过程中也存在着总控指标的制定、费用转移、支付机制、管理等方面的问题。在全国推广上海经验时，值得首先对上海市的总控政策作进一步深入的分析。     

Health technology assessment in Greece

In 1983 a health reform aimed to assure universal coverage and equity in the distribution of services in Greece. The reform implied state responsibility for the financing and delivery of services and a reduction of the private sector. The model was a Bismarckian scheme for social insurance. However, healthcare delivery remains fragmented and uncoordinated and the private sector is getting stronger. The dominant payment system is fee-for-service for the private sector and administered prices and salaries for public hospitals and social insurance funds. The many insurers have their own eligibility requirements, validation procedures, etc. Coverage of services by social security funds, probably among the most comprehensive in Europe, is determined more on historical and political grounds than on efficiency or cost-effectiveness. The system is plagued by problems, including geographical inequalities, overcentralization, bureaucratic management, poor incentives in the public sector, open-ended financing, inefficient use of hospital beds, and lack of cost-effectiveness. There are no specific legal provisions for the control of health technology. Technologies are introduced without standards or formal consideration of needs. There are no current efforts to control health technology in Greece. However, health technology assessment (HTA) has gained increasing visibility. In 1997 a law provided for a new government agency responsible for quality control, economic evaluation of health services, and HTA. The hope is that the new law may introduce evaluation and assessment elements into health policy formulation and assure that cost effectiveness, quality, and appropriate use of health technology will receive more attention.