试论新形势下我国医疗卫生管理人才的培养——中美卫生管理人才培养模式比较

我国卫生管理人才的培养由于一直是在传统的计划经济体制和卫生行政管理体制的框架内发展,同时又受到单一的学术型学位培养制度的限制,所以,不能满足卫生医疗行业管理岗位的要求.而且,随着人们健康和医疗卫生需求的多元化,以及医学和科技的发展,我国传统的社会医学与卫生事业管理专业的人才培养方案,已经不能满足当前我国医疗卫生行业的管理人员所从事工作岗位的要求.文章以美国卫生管理人才培养体系和培养方案为参照,结合现阶段我国医疗卫生的行业特征,分析探讨了适合新形势下我国职业化卫生管理人才的培养和教育问题,提出了以管理科学、卫生经济学为专业核心课程,以卫生学、医疗行业知识、经济学、社会学等学科为专业基础的课程培养模式.     

医疗卫生资源配置区域差异化研究综述

医疗卫生资源是人们维护健康的物质基础,其合理配置是卫生事业可持续发展的基础。但由于各国地区间经济实力、人口分布、文化教育、地理、交通条件等发展不平衡以及其他特殊因素,会导致区域间医疗卫生资源配置呈现差异化发展态势,这是医疗卫生领域不公平的重要体现。因此,研究并解决卫生资源配置区域间的差异化问题是卫生经济学研究的一项重要课题。国内外诸多学者围绕医疗卫生资源配置区域差异化问题展开大量研究,这些研究为进一步全面认识和探讨如何消除我国医疗卫生资源配置区域差异化问题,实现医疗卫生资源配置均等化提供了理论基础和经验借鉴。     

我国卫生经济学教育的现状、机遇与挑战

目的:了解我国卫生经济学教育的发展现状、面临的机遇与挑战,并提出改进建议。方法:综合运用文献分析法和问卷调研法,从学科、专业、课程3个层面分析我国卫生经济学教育的现状以及存在的问题。结果:在综合性高校,卫生经济学具有较强的学科基础,然而,医药类院校的医疗卫生的专业实力雄厚,经济学却是发展短板。在课程设置方面,开设层次与学科专业发展水平密切相关,开设单位和授课对象多元化。教材选用以国外教材居多,国内教材的内容较为系统全面。卫生经济学的师资团队呈现高学历和跨学科的特征。教学模式以传统讲授模式和研讨式教学模式为主,问题导向教学模式和案例教学模式运用相对较少。讨论与建议:步入新时代,新医改政策助推卫生经济学教育。我国的卫生经济学教育应顺应变化趋势,在确保学科独立地位的同时,在条件成熟的高校设置健康经济学这一特设专业,为国家的卫生事业发展培养更多的优秀人才。     

建立医院经济效益指标体系的管见——兼与马俊林王钦同志商榷

《卫生经济》1983年第3期发表了黑龙江大学经济系马俊林、王钦同志的《论医疗卫生经济效益指标体系》(以下简称《体系》)一文,以马克思主义经济学的观点,阐明和论证了医疗卫生单位经济效益的客观存在,明确提出建立医疗卫生     

卫生经济理论的若干问题——在卫生经济理论研讨会上的发言

一、医疗卫生劳动是不是生产性劳动研究卫生经济问题,不能只谈卫生,也不能只谈经济学,而是要从卫生经济学的角度来讨论卫生事业的发展问题。有的同志说,研究卫生经济问题不一定非得谈     

结构经济分析及其在卫生服务领域中的应用

阐述卫生服务领域中开展结构经济学分析的必要性和重要意义，指出卫生服务领域开展结构经济学研究是合理利用卫生服务资源的需要，是发现医疗卫生服务系统中深层次问题的需要，也是发展卫生经济学研究方法的需要。     

征稿启事

正《国外医学卫生经济分册》杂志是由中华人民共和国国家卫生和计划生育委员会主管,江苏省医学情报研究所主办,中国卫生经济学会协办的国家级杂志,面向国内外公开发行。为适应我国医疗卫生改革发展的需要,深化国内医疗卫生改革热点和难点问题的研究与探讨,我刊在保留原有的介绍"国外卫生经济与管理"的特色之外,开辟了以国内医疗卫生改革热点和难点问题为主的《国内卫生经济与管理论坛》栏目,重点介绍和探讨中国卫生政策与发展、医疗卫生改革动态、医疗保险运作与管理、     

卫生管理也是财源

医疗卫生单位资金的人效利用是卫生经济学一直在研究的问题,并始终贯穿 我国卫生经济理论和卫生经济实践活动之 。笔者认为,科学管理出效益,通过改革卫生管理体制、制度、政策、方式和方法,优化人、财、物的组合,充分调动医疗卫生单位广大职工的积极性和创造性,提高卫生经济效益是医疗卫生单位成功的关键,也是重     

征稿启事

<正>《国外医学·卫生经济分册》杂志是由中华人民共和国国家卫生和计划生育委员会主管,江苏省医学情报研究所主办,中国卫生经济学会协办的国家级杂志,面向国内外公开发行。为适应我国医疗卫生改革发展的需要,深化国内医疗卫生改革热点和难点问题的研究与探讨,我刊在保留原有的介绍"国外卫生经济与管理"的特色之外,开辟了以国内医疗卫生改革热点和难点问题为主的《国内卫     

征稿启事

《国外医学·卫生经济分册》杂志是由中华人民共和国卫生部主管,中国卫生经济学会协办,江苏省医学情报研究所主办的国家级杂志,面向国内外公开发行。为适应我国医疗卫生改革发展的需要,深化国内医疗卫生改革热点和难点问题的研究与探讨,我刊在保留原有的介绍“国外卫生经济与管理”的特色之外,已于2008年开辟了以国内医疗卫生改革热点和难点问题为主的《国内卫生经济与管理论坛》栏目,重点介绍和探讨中国卫生政策与发展、医疗卫生改革动态、医疗保险运作与管理、医疗机构改革与管理、     

A research agenda for public health workforce development.

In the past decades, public health research has focused on categorical rather than cross-cutting or systems issues. Little research has been carried out on the infrastructure required to support public health programs. This article describes the results of an interactive process to develop a research agenda for public health workforce development to inform all those with stakes in the public health system. This research is defined as a multidisciplinary field of inquiry, both basic and applied, that examines the workforce in terms of costs, quality, accessibility, delivery, organization, financing, and outcomes of public health services to increase knowledge and understanding of the relationships among workforce and structure, processes, and effects of public health services. A logic model and five priority research areas resulted from meetings of expert panels during 2000 to 2003. Innovative public and private partnerships will be required to advance cross-cutting and systems-focused research.     

Medical workforce planning. Spreading the load

Medical workforce planning is a difficult and neglected area, but ignoring it will cost the NHS dear. Setting up collaborative mechanisms to deal with medical training and workforce issues is not easy, but has been shown by one health authority to be worthwhile. Plans for an 8 per cent increase in consultant posts will, if implemented, cost the HA 700,000 Pounds a year in salaries and on-costs alone, but better information has enabled the most beneficial to be prioritised.     

Ethical and legal issues confronting college health.

More than 11 million students currently attend institutions of higher education in the United States. While this segment of the population traditionally constitutes a young, healthy cohort, experience demonstrates that college and university health services play a critical role in assuring student health maintenance, completion of school, consumer health education, and the development of sound health practices and behaviors. In examining institutional policies and protocols governing the support and the delivery of student health services, several critical ethical issues emerge from both a macro and micro orientation. As university and college resources become more scarce and budget decreases increase, institutions are reestablishing priorities. Oftentimes, the question of continued support of campus based health services is raised. Suggestions range from discontinuing their operation, to dramatic decreases in their services, to requiring them to become fully self-sufficient (i.e., through mandatory prepayments or fee-for-services mechanisms and elimination of general fund support). At a macro level, such discussions raise issues associated with social justice and whether the universities and colleges should serve in a loco parentis (paternalistic) role. This essay more specifically addresses several micro issues that directly impinge on the delivery of health services to millions of college and university students.     

Motivational interviewing in health care settings. Opportunities and limitations

Motivational interviewing (MI) has been well studied in specialist settings. There has been considerable interest in applying MI to community health care settings. Such settings represent a significant departure from the more traditional, specialist settings in which MI has been developed and tested.The purpose of this paper is to provide a brief overview of MI and to identify and discuss the key issues that are likely to arise when adapting this approach to health care and public health settings. This paper provides an overview of important issues to consider in adapting an effective counseling strategy to new settings, and is intended to begin a dialogue about the use of MI in community health care settings.     

Health outcomes. New quality measure for Medicare.

OBJECTIVE: A new measurement of health care quality for Medicare beneficiaries has been implemented by the Health Care Financing Administration (HCFA). This paper describes the program, presents baseline data and highlights associated issues. DESIGN: The Health Outcomes Survey (HOS) is a longitudinal cohort mail survey. Changes in population health status after 2 years will be evaluated on an individual plan level. SETTING: Two-hundred and eighty-seven US Medicare managed care plans. MAIN OUTCOMES MEASURES: Physical component and mental component summary scales derived from the SF-36. FINDINGS: Baseline data documented lower health status in older populations, while functional limitations and disease prevalence were higher. Among different plans, mean functional levels were found to be similar, although a few plans contained populations with exceptionally low levels. These data do not support the assertion that enrolees in for-profit plans are healthier than non-profit plans. CONCLUSIONS/IMPLICATIONS: The HOS is the first large-scale program to evaluate health outcomes among older Americans. HCFA recognizes several technical and policy issues. Technical issues include possible biased reporting for subpopulations, the validity of proxy responses and respondent burden. Policy issues concern the appropriateness of using a generic measure such as the SF-36 and how much change in health status can be attributed to quality of health care. HCFA plans to extend the HOS to beneficiaries in traditional Medicare. The HOS project is expected to encourage more efforts to maintain or improve the health status of the Medicare managed care population.     

Communicating health risk.

Health risk communication is a two way interactive process that involves the exchange of information among interested parties about the nature, magnitude, significance, or control of a risk. Although it has only recently become a topic for scientific research, much has been learned in relation to the strategies and the techniques that contribute to effective health risk communication. In parallel, there has probably never been a time of greater need for effective training in health risk communication. The media and the general public are now very hazard conscious, subsequent to apparently regular events in the areas of public health, safety and environmental issues. Public concern regarding such issues is sometimes much less than experts feel to be appropriate, whilst at other times concern has outstripped the concern of the experts involved. Health professionals trained in the techniques of health risk communication are a vital resource in ensuring that the workforce or the population is properly informed so as to exercise appropriate decisions and actions in relation to hazard and risk.     

Ethics and financing: overview of the U.S. health care system

An overview of the financing decisions that occurred with the U.S. health system during the past five decades was presented in relation to the ethical issues which gave rise to and resulted from those financing decisions. This health system evolved from decision-making grounded in altruism through increasing the access and supply of resources to a position of caution and financial prudence. Recently the decision-making became grounded in pragmatism with the realization that attempts to provide everyone with all possible health services on demand cannot be achieved. Financing decision have resulted in a health care system based on acute care and sophisticated technology but with too many hospital beds and physicians, both geographically maldistributed. Since this acute care system has been successful in preventing premature deaths, our population now lives longer and develops chronic illnesses which require different interventions; the system has neglected to focus on prevention and adequate care for long-term diseases. It has created a growing population of uninsured who are unable to afford health care when illness occurs. Alternative strategies were discussed at three levels of the health system. At the overall system level, the following was proposed: consistent application of ethical principles most appropriate to allocation decisions and the creation of health policy which encompasses chronic care and disease prevention components. At the organizational level, health administrators and local community leaders must cooperatively address local health issues; medical education should focus on long-term care and disease prevention; and medical practice should reduce variation in treatment patterns. At the population level, healthy lifestyles must be encouraged in addition to the development of alternative reimbursement plans to maximize access to health care. Davis and Rowland (1990:298) have stated that our nation's image is strained" ... as a just and humane society when significant portions of the population endure avoidable pain, suffering and even death because of an inability to pay for health." These are turbulent times in health care but addressing the ethical issues at many levels may lead to successful alternatives and ultimately to a workable health strategy for this country.     

Environmental health in the journals.

The environmental health aspects of general medical practice have attracted the attention of many professional organizations in the past few years, including the American College of Physicians, the Institute of Medicine, and the American College of Occupational Medicine. To assess the degree of emphasis placed on environmental health issues in professional journals, a survey of representative specialty and general medical journals was conducted through a Medline literature search. Over the past 15-year period (1976-1990) specialty journals demonstrated a dramatic and consistent increase in published articles that were indexed under the headings environmental pollution, environmental pollutants, and environmental cancer. General medical journals also demonstrated continued increases in the rate of published articles addressing these environmental health topics. Within the environmental categories, air pollution, especially that due to dusts, was the most heavily indexed topic, followed by water pollution, especially that due to chemical contamination. This study supports the notion that environmental health issues are assuming more importance in general medical practice, especially within the specialty of occupational medicine.     

Public health issues.

In a recent MSMS survey, MSMS members ranked public health as one the top five issues of major concern to Michigan physicians. Tobacco use, chronic illness, and HIV-infected health care workers comprise some of the major public health issues facing physicians and patients in Michigan. Following is a brief examination of each of these issues. Also included is a brief discussion of medical doctors as public health directors. Should all public health directors be medical doctors? This question is addressed in this cover story.     

老年疾病负担与公共卫生服务

随着人口老龄化在世界范围蔓延,我国的老龄人口健康问题引起了社会的广泛关注。老年人面临的疾病负担成为卫生服务研究中的重要内容。老龄人口作为健康领域中的弱势群体,在生理、心理和社会适应性方面都弱于青壮年,这就对我国公共卫生服务提出了更高的要求。