“个体化”视角下的农村医疗卫生政策实施

农村医疗卫生政策是国家和政府用于解决农民医疗保障问题、保证农民医疗保障权利的社会政策,其实施改变了政府在农村医疗卫生保障中责任相对缺失的局面,与农民的个体化密切相关.然而,由于农村医疗卫生政策本身、政策执行过程及政策环境存在的问题,农村医疗卫生政策并不能完全满足农民的“个体化”需求,甚至会产生“去个体化”效果.作为一项以农民为目标群体的社会政策,农村医疗卫生政策若想取得更好的政策效果,应当提供更多政策参与途径来吸收农民参与,这既是顺应、引导农民个体化的需要,也是政策本身的需要.     

可持续发展视角下新型农村合作医疗制度建设的思考

新型农村合作医疗自2003年试点以来,取得了举世瞩目的成绩。但在推进过程中,制度内外也出现了一些新的问题和矛盾,影响了新型农村合作医疗制度的可持续发展。因而,需要采取增加政策支持、建立法律保障、强化监管、优化农村卫生服务体系等来改善新型农村合作医疗制度的运行环境;建立稳定的筹资与增长机制、科学的补偿机制、有效的费用控制机制和严格的管理机制来优化新型农村合作医疗制度建设。     

Being sued in rural practice? A perspective from the USA

ABSTRACT: Information about the human dimension of medical litigation, better known as being sued, is sparse, particularly as it relates to physicians who arc in rural practice in the USA. Stemming from demographic, cultural and socioeconomic factors, physician-community dynamics in rural areas differ from those in more populated settings. Those dynamics probably are similar in rural communities worldwide. This article focuses on the impact of litigation on rural physicians who practise in the USA. However, the information may also be applicable to physicians in other countries, in this case Australia. The information herein is based on the literature, observing and talking with rural physicians and other health care providers who have been involved in some way with the legal or court systems, interviews with lawyers, personal experiences while living and working in rural environments, as well as having served as expert witnesses for cases involving rural health care providers.     

从费用控制角度谈新农合可持续发展

费用控制对新农合的可持续发展起着关键作用。文章从医疗服务的需方、供给方和合作医疗经办机构三方面谈费用控制不当阻碍新农合可持续发展的因素，探讨解决的办法，提出措施：提高农村基层医疗机构的服务能力；规范定点医疗机构的医疗行为；改变新农合费用支付方式；规范患者不合理就医；加强立法与监管，完善农村医疗保障体系。     

基于需求视角的乡村医生养老保障研究

乡村医生养老保障问题是亟待解决的难题之一。文章从需求的角度出发,通过文献研究法系统地梳理乡村医生养老保障相关文献,探讨乡村医生养老保障研究现状,发现存在的问题,在此基础上为解决乡村医生养老后顾之忧提出参考性建议。     

New South Wales rural general practice from a Yank's perspective

ABSTRACT: The author, a family practice specialist from Minnesota in the United States, worked as a locum in rural New South Wales for 6months. This provided him with the opportunity to reflect on the differences between the specialty of family practice in his home state of Minnesota and general practice in New South Wales; and to recognise that general practice in New South Wales is at a crossroads. This paper highlights the need for general practitioners (GPs) to work together and support each other, to provide quality care and to lobby both State and Commonwealth governments on the importance of broadly trained GP specialists in rural communities. To influence the future of their profession, GPs in New South Wales need to focus on quality of care and on educating themselves, their colleagues and the communities in which they work.     

The homemaker needs of the rural frail elderly from a client versus agency perspective

The clients, aides, and staff of a homemaker services program for the rural frail elderly were individually interviewed concerning client's met and unmet needs. While the overall response from all three groups suggested a highly effective program, significant differences existed among the three groups with regard to what they considered the most important needs, both met and unmet by the program. It was concluded that although the perceptions of all three groups of participants in such programs might differ, such differences may not necessarily work to undermine the program.     

分级诊疗视角下山东省村卫生室的供给侧分析

目的:对分级诊疗制度下山东省村卫生室的供给侧进行分析。方法:基于供给侧理论,运用Cobb-Douglas函数进行定量分析。结果:2012—2014年,山东省固定资产、基本药物补助和人力资源三类资源供给要素的弹性系数分别为0.110、0.218和0.495;人力资源减少对卫生室服务产出下降的贡献率最大,为92.620%。2012—2014年,山东省固定资产弹性系数略有上升,基本药物补助的弹性系数明显下降,人力资源弹性系数先升后降。结论:山东省村卫生室发展处于规模效益递减状态,人力资源是卫生室发展最为重要的动力源,人力资源不足成为当前制约卫生室发展的主要原因,财政投入对卫生室发展的推动力不足且不断弱化。     

反贫困视角下的农村医疗保障制度的问题与选择

目的:从反贫困视角分析农村医疗保障制度的问题,并提出相应的政策建议.方法:以经济欠发达地区为主,考虑区域分布,选择了浙江省遂昌县、江山市、普陀区等9个项目县,采用资料查阅、专题小组座谈和深度访谈相结合的调研方法.结果:2009年项目县参合农民中贫困人口的比例最高达5.05％,最低为1.31％,大部分项目县在2％以上.当前农村医疗保障制度在反贫困中的主要问题有“逆向转移支付”现象,医疗救助制度难以发挥应有作用.结论:新农合政策在制度设计上要更多地关注和倾斜于贫困农民,应该对贫困农民单独制定特殊的补偿优惠政策,并完善农村医疗救助制度,加强与新农合制度的衔接.     

Viewpoint: managerial imperatives.

The development of an institutional culture cannot be left to chance. One must articulate the desirable managerial variables that will establish the mores of and for the institution. When these are known and become the basis for the actions and activities of those who are part of the institution, the operational results will be satisfactory and desirable.     

Telecommunications and disabled people: a rural perspective

In the context of the National Health Service and Community Care Act 1990 this paper focuses on the role of home- and community-based telecommunication services in sustaining the life-style and independence of elderly and disabled people in rural Britain. It draws on findings from a recent survey in the North Cotswolds to evaluate four models of telecommunication support: telephone trees; community alarm systems; community teleservice centres (CTCs); and on-line computer systems. The arguments in favour of a "low-cost-voluntary-care-support-model", a variant of the CTC, are discussed with respect to client need and community setting.