换个思路看补偿之争

卫生部部长陈竺在向全国人大常委会提交的“关于城乡医疗卫生体制改革和加强食品药品安全监管情况的报告”中，就人们关心的新医改方案中政府补偿问题，明确提出了“政府投入兼顾医疗服务供方和需方”。在许多人看来，“补需方”的提出者和推动者反对“补供方”，意味着政府财政一分钱都不能投入供方。实际上，“补需方”的提出者和推动者真正反对的是一种特殊的补供方方式，     

试析支付方式对卫生服务供给的影响

卫生费用支付方式是患者(需方)或医疗保险机构对医疗服务提供者(供方)支付医疗服务费用的方式。医疗费用的支付方式是医疗保险制度改革的重要环节，也是影响医疗目标实现的重要因素之一，对医疗机构的医疗服务行为具有一定的影响。如何有效地改革和完善医疗费用支付方式，在供方、需方、医疗保险机构之间形成有效的利益约束机制，使基本医疗服务费用保持在当地适当水平，从而有效地使用有限的卫生资源，确保满足需方的基本医疗需求、     

基本卫生服务中政府补偿的方式选择

由于基本卫生服务的特殊性,政府需要对此进行干预以保证居民享有基本卫生服务,可选择的方式主要有补供方和补需方.运用卫生经济学理论和公共经济学理论,阐述了补供方和补需方的理论依据,分析了两者的特点和适用条件.以农村基本卫生为例,分析了农村卫生中财政补助的政策选择.强调无论是补供方还是补需方,都需制定适宜的配套政策和监管措施,才能保证政策的效果.     

公立医院改革的三个重点环节

笔者认为，公立医院改革应重点抓好以下三个环节： 一、明确政府责任 实现管办分离 政府加大投入，应补供方还是补需方是争论已久的问题。笔者认为政府应该主要补需方，以促使医疗机构加强管理。一旦补供方就必然要加强监管，而目前缺乏简便、科学、有效的监管。     

对公立医院改革要有实质性措施

解决看病难和看病贵问题,必须是医疗服务的购买能力和供给能力同步发展,协调平衡。针对当前许多人缺乏医疗保障（购买能力不足）以及部分地区医疗机构服务能力低下（供给不足）的情况,作为主导医疗卫生事业发展的政府,无论是补需方,还是补供方都是有道理可言。补供方和补需方,并不是非此即彼的关系。     

中等规模公立医院如何应对医改

新的医改方案将使我国各级医院面临严峻的挑战，也是新的发展契机。政府投入采取对医疗服务供方、需方同时补贴的折衷办法，无论怎么补需方，都不能代替供方能力的建设。因此，要更加理性地思考医院的发展规划，明确医院的定位与竞争方向，做好资源重组与结构调整。作为中等规模医院，要坚持“外科优先、内科精品、基础领先”的原则，积极应对医改的挑战。     

关于基本医疗服务若干问题的思考

本文认为,基本医疗服务就是基本医疗保障制度面向参保人员提供的医疗服务。是否属于基本医疗,不以供方提供什么医疗服务为标准来认定,而是需方对少花钱、看好病的一种现实体验和感受。为此建议：统一“基本医疗服务”概念,加大政府对基本医疗服务的投入,改革医保管理体制。     

补供方而不是养供方

新医改方案已经明确,政府要‘增加对医疗卫生事业的投入,而投入要兼顾医疗服务的供方和需方。问题在于,政府“补供方”的投入究竟如何？在这个问题上,有两种思路浮出水面：一是政府全额支付公立医疗机构的职工工资;其二是政府购买服务,根据服务契约向服务提供者支付合同款。     

政府投入兼顾医疗服务供方和需方的可操作性研究

政府对卫生费用投入的有限性,决定了其对供需双方补给的局限性.文章通过分析政府投入只补给供方或只补给需方产生的主要问题,试图探索政府投入兼顾医疗服务供方和需方的可操作性方式,使其更好地抑制医疗费用,服务群众.     

支付制度对医疗服务需求和利用的影响分析

通过比较需方和供方风险分担机制样本人群的门诊医疗服务需求和利用情况,探讨支付制度对医疗服务需求和利用的影响.结果显示两种机制对医疗服务强度均产生重要影响,另外,需方费用分担主要影响医疗需求,而供方分担则主要影响服务数量.为此建议：对需方的成本制约应充分考虑服务利用的可及性和公平性,对供方的成本制约应考虑服务利用的有效性和分险承担的可行性.     

The "lessons" of the Australian "heroin shortage"

Heroin use causes considerable harm to individual users including dependence, fatal and nonfatal overdose, mental health problems, and blood borne virus transmission. It also adversely affects the community through drug dealing, property crime and reduced public amenity. During the mid to late 1990s in Australia the prevalence of heroin use increased as reflected in steeply rising overdose deaths. In January 2001, there were reports of an unpredicted and unprecedented reduction in heroin supply with an abrupt onset in all Australian jurisdictions. The shortage was most marked in New South Wales, the State with the largest heroin market, which saw increases in price, dramatic decreases in purity at the street level, and reductions in the ease with which injecting drug users reported being able to obtain the drug. The abrupt onset of the shortage and a subsequent dramatic reduction in overdose deaths prompted national debate about the causes of the shortage and later international debate about the policy significance of what has come to be called the "Australian heroin shortage". In this paper we summarise insights from four years' research into the causes, consequences and policy implications of the "heroin shortage".     

Correlates of the "western" and "prudent" diet patterns in the us

PURPOSE: Underlying the diversity and changeability of US eating habits are fundamental dietary patterns shaped by common sociohistorical experiences. Currently, little is known of what patterns exist or their associations with sociodemographic/lifestyle factors. We examined these issues in third National Health and Nutrition Examination Survey data.METHODS: Analyses were based on 5,794 US-born, white participants. Interviews included a 60-item food frequency questionnaire (FFQ) and questions on sociodemographics and health behaviors. Dietary patterns were identified by principal components analysis on FFQ responses. Component scores representing intake level of each pattern were dichotomized at the median. Logistic regression analysis was used to estimate odds ratios (OR) and 95% confidence intervals (CI).RESULTS: We identified two primary dietary patterns-a "western" pattern characterized by processed and red meats, eggs, potatoes, and refined grains, and a "prudent" pattern characterized by cruciferous vegetables, greens, carrots, salads, and fresh fruits. The two patterns occurred across geographic regions and in both women and men. After age- and sex-adjustment, the "western" diet was associated with rural residence (OR = 1.9, 95% CI 1.7-2.2), working class status (OR = 1.4, 95% CI 1.2-1.6), and lack of high school completion (OR = 1.6, 95% CI 1.4-1.8). The "prudent" diet was associated with high school completion (OR = 2.8, 95% CI 2.5-3.3) and behaviors reflecting greater health awareness, such as daily physical activity (OR = 2.0, 95% CI 1.8-2.2), non-smoking (OR = 2.1, 95% CI 1.8-2.4), and supplement use (OR = 1.8, 95% CI 1.6-2.0).CONCLUSIONS: The two dietary patterns resemble those found in previous US studies. Findings regarding correlates agree with social histories describing the emergence of those patterns. Principal components analysis is potentially useful for identifying fundamental dietary patterns for future investigations of diet-disease associations.     

健康是"1"财富是"0"

越来越多的职业人在越来越多的时间里感到疲劳．或者疲劳成为了日常性的，甚至于连疲劳感都变得模糊了。以此为标志．职业人已经走进了一个多事的过劳时代。