关于卫生事业计划与市场调节相结合的研究

今年4月,七届全国人大四次会议批准了《国民经济和社会发展十年规划和第八个五年计划纲要》(简称《纲要》,下同)。指出:“今后十年要初步建立社会主义有计划商品经济的新体制,建立计划经济与市场调节相结合的运行机制,”这是深化经济体制改革的基本方向和总目标,也是卫生事业发展和改革的指导方针。卫生事业是国民经济的重要组成部分。今后十年,卫生事业的发展和卫生改革,怎样才能按照《纲要》提出的要求,根据卫生部门的特点,建立起计划经济与市场调节相结合的运行机制。对此,谈一点粗     

发展医疗卫生事业推动经济社会建设

今年继卫生两会、国家两会之后,国务院常务会议原则通过《卫生事业发展“十一五”规划纲要》(简称“卫生规划纲要”)。科技部、卫生部、中医药管理局、国家食品药品监督管理局等16个部门联合发布《中医药创新发展规划纲要》(2006～2020年)(简称“中医药发展纲要”)。这是关系国计民生和13亿人民健康的大事,对于积极推动医疗卫生事业与经济建设协调发展可谓走出了关键的一步。     

论卫生事业性质的双重标准与卫生改革的关系——学习《中共中央、国务院关于卫生改革与发展的决定》的体会

《中共中央、国务院关于卫生改革与发展的决定》(以下简称《决定》),明确了我国卫生事业的性质,为我国卫生事业的发展指明了方向,也为深化卫生改革提供了基本依据。笔者拟就我国卫生事业性质的标准及其与卫生改革、发展的关系等问题,谈点学习体会。 一、对我国卫生事业性质涵义的理解     

四川省卫生厅卓凯星厅长谈卫生改革与医政管理

在学习十五大精神和贯彻中共中央,国务院《关于卫生改革与发展的决定》的时候,要注意两者的有机结合,发展卫生事业,既要坚持为人民健康服务,为社会主义现代化建设服务的方向,又要走发展才是硬道理的路子,正确处理好改革力度、发展速度和社会承受程度三方面的关系。这对搞好医政工作尤其重要: 首先,在卫生改革方面,我们要认真研究医疗单     

1992年全国卫生统计工作要点

1992年,各级卫生部门要根据《卫生事业第八个五年计划和2000年规划设想》以及《全国卫生统计工作发展规划纲要(1991-2000年)》,继续认真抓好各项统计基础建设,加强统计工作的法规化、制度化管理,提高统计人员的政治思想素质和业务素质。统计工作要围绕今年全国卫生工作会议精神,努力搞好信息、咨询服务,在我国卫生发展与改革的新形势下,更加适应卫生事业宏观决策和科学管理的需要。     

在全国卫生工作会议上的总结讲话(要点)

一 这次大会主要解决了我国卫生事业改革与发展的大政方针问题,概括起来主要有以下几点: (一)指出了卫生事业在我国经济社会发展中的重要地位和作用。 (二) 明确了我国卫生事业的性质和卫生工作的方针,强调卫生机构必须坚持为人民服务的宗旨,正确处理社会效益和经济效益的关系。     

九五期间卫生信息化建设的主要目标和任务

在1997年12月召开的《全国卫生信息化工作会议》上,讨论通过了《卫生系统信息化建设九五规划及2010年远景目标(纲要)》(以下简称《规划》)。《规划》对于各级卫生行政领导如何适应国家国民经济信息化的形势,如何利用国家信息化及卫生信息化来促进卫生事业的发展及卫生改革的深入,提出了要求。要求各级领导要从卫生事业发展需要的高度出发,提高对于卫生信息化工作重要性的认识,把卫生信息化程度作为衡量卫生管理科学化、现代化水平的重要标志。     

健全财政经费保障机制

紧张忙碌的2007年，卫生部规划财务司司长赵自林最感有收获的事情当属编制完成了《卫生事业发展“十一五”规划纲要》。他透露，《卫生事业发展“十一五”规划纲要》是全国11个重点专项规划之一，与以往不同的是，“十一五”规划纲要是经国务院常务会议研究通过并发布实施的。科学制定卫生事业发展规划，指导卫生事业健康、可持续发展，既是今后卫生工作的中心任务，也是规划财务工作的重要内容。另一件令赵自林司长很有成就感的事，     

有关我国卫生事业性质的文献资料摘编

在《中国卫生发展与改革纲要》起草过程中,我们查阅了建国以来的文献资料,现将与我国卫生事业性质有关的论述(已公开部分)摘编如下,从中可以看出卫生事业福利性观点的形成、演变过程与主要内容,谨供有关学者和各级领导同志在进一步探讨问题时参考。     

卫生改革发展要处理好的几个关系

我国医药卫生体制改革已经进入攻坚阶段,本文结合卫生事业发展规律和卫生改革实践,认为深化卫生改革需要从宏观和微观两个方面进行进一步调整.宏观方面需要进一步处理好卫生与经济、改革与发展、医疗保障多数与少数、政府投入常态与专项等关系,微观方面需要进一步处理好基本医疗和特需医疗、公立医院改革的公平与效率、体系建设的人才与硬件等关系,并就如何处理好这些关系提出相应建议.     

“十二五”期间深化医药卫生体制改革规划述评

国务院颁布的《＂十二五＂期间深化医药卫生体制改革规划暨实施方案》紧密围绕2009年《中共中央国务院关于深化医药卫生体制改革的意见》精神,部署了今后四年我国深化医药卫生体制改革的具体任务和重点工作。《规划》为缩短我国卫生事业与经济发展的差距奠定了坚实的基础。     

Large-scale organizational and managerial change in health care: a review of the literature

This paper takes an overview of the organizational and managerial literature on recent large-scale change efforts within health care organizations. Such literature refers to issues of enhanced policy significance, as a succession of such changes has swept through health care, at an international level. Interpretive and case study method have been widely employed in this field. While the literature is emergent, key empirical concerns can be identified: (1) Changing roles and relationships, with the rise of management and the challenge to clinical domination; some argue that radical deprofessionalization now is evident, while others take a more nuanced view. (2) The impact of marketization, with health care becoming more of a commodity; various models of a health care 'quasi market' have been formulated. (3) Understanding the process of change in health care organizations, such as the development of a management of change literature. New theoretical frameworks have been developed, notably 'the reform cycle' as a way of understanding progressive cycles of organizational reform, the impact on health care of the rise of the new public management, and examining the demedicalization thesis through the more generic literature on professions. The paper concludes with a discussion of what this research base could contribute to policy-making.     

关于我国医疗服务价格项目规范的思考

介绍了我国医疗服务价格项目规范的研究现状,描述了<全国医疗服务价格项目规范>在卫生改革中的作用,提出要进一步完善医疗服务价格体系:①"按项目付费"是其他医疗支付方式的基础;②加强各省的师资培训,确保<项目规范>的正确实施;③建立特殊医疗消耗用品目录,加强耗材使用管理;④制定全国统一的医疗服务项目价格系数;⑤深入开展符合我国国情的医疗付费方式研究;⑥制定各学科临床诊疗规范;⑦建立与国际接轨的编码体系.     

我国的医疗改革还有希望吗

期望“三项改革”在短期内取得突破,只有变目前的按服务项目收费为“总额预算”基础上“按服务量（服务单元）”收费,舍其别无他法。此办法将带来下列直接好处：（1）根除看病责问题,纳医疗费用增长在社会可承受范围;（2）彻底扭转以药养医,医院将出现药品平价进平价出;（3）社会各方利益容易协调。三项改革目标也得以实现。     

Vers des nouvelles perspectives d'appui à la Prévention au Système National de la Santé, en Tunisie

"Prevention", a component of primary health care since Alma Atas declaration (1978), has been a strategic axis of health policy in Tunisia for four decades. If the Tunisian Revolutionary Constitution (2014) declared in its Article 38 that "the State guarantees prevention", the regulatory texts, organizing preventive structures and its operational programs, have today become ill-suited with the global burden of disease and current scientific evidence. The analysis of current preventive practices in Tunisia, based on the "health continuum", the taxonomy of "preventive strategies" and the identification of "vulnerable populations", has shown the need to implement prevention activities. "Primordial" and "quaternary" (for the management of cardiovascular diseases and cancers), extension of the fields of health education and epidemiological surveillance, towards Therapeutic Education of Patients / Health Promotion, and health monitoring, and coverage of new groups at risk: adolescents and the elderly. Faced with the multitude of prevention structures and the fragmentation of health programs, the reform of the national preventive policy and its practices should be based on the principles of integration, relevance and efficiency, through the establishment of a National Health Protection Agency (NHPA). This ANP is called upon to launch new prevention support projects including integrated preventive medicine centers (providing periodic health examinations), hospital patient therapeutic education services and home care units. Such a reform, announcing the birth of a new generation of preventive basic health care activities in Tunisia, should be reinforced by a legal, organizational and educational basis.     

The Chinese health care regulatory institutions in an era of transition

The purpose of this paper is to contribute to a better understanding of Chinese health care regulation in an era of transition. It describes the major health care regulatory institutions operating currently in China and analyzes the underlying factors. The paper argues that in the transition from a planned to a market economy, the Chinese government has been employing a hybrid approach where both old and new institutions have a role in the management of emerging markets, including the health care market. This approach is consistent with the incremental reform strategy adopted by the Party-state. Although a health care regulatory framework has gradually taken shape, the framework is incomplete, with a particular lack of emphasis on professional self-regulation. In addition, its effectiveness is limited despite the existence of many regulatory institutions. In poor rural areas, the effectiveness of the regulatory framework is further undermined or distorted by the extremely difficult financial position that local governments find themselves in. The interpretations of the principle of 'rule of law' by policy makers and officials at different levels and the widespread informal network of relations between known individuals (Guanxi) play an important role in the operation of the regulatory framework. The findings of this paper reveal the complex nature of regulating health care in transitional China.     

Economics and ethics in mental health care: traditions and trade-offs

BACKGROUND: Both economic and ethical perspectives are exerting increasing influence at all levels of mental health policy and practice; yet there is little consensus on how these two different perspectives are to be reconciled or explicitly incorporated into decision-making. AIM: This review article is directed towards a fuller understanding of the complex trade-offs and compromises that are or may be made by clinicians, managers and policy-makers alike in the context of mental health care planning and delivery. METHOD: We briefly outline a number of key principles of health care economics and ethics, and then focus on the particular incentives and trade-offs that are raised by these principles at three levels of the mental health system: government and society; purchasers and providers; and users and carers. RESULTS: At the level of government and society, we find (economically influenced) attempts to reform mental health care offset by concerns revolving around access to care: whether society is prepared to forgo economic benefits in exchange for improved equity depends to a considerable extent on the prevailing ethical paradigm. The implementation of these reforms at the level of purchasers and providers has helped to focus attention on evaluation and prioritization, but has also introduced "perverse incentives" such as cost-shifting and cream-skimming, which can impede access to or continuity of appropriate care for mentally ill people. Finally, we detect opportunities for moral hazard and other forms of strategic behaviour that are thrown up by the nature of the carer:user relationship in mental health care. CONCLUSION: We conclude by highlighting the need to move towards a more open, accountable and evidence-based mental health care system. Acknowledgement of and progress towards these three requirements will not deliver ideal levels of efficiency or equity, but will foster a greater understanding of the relevance of ethical considerations to mental health policies and strategies that are often influenced strongly or solely by economic arguments, whilst also demonstrating that equity must come at a price.     

我国医保支付方式改革的有效性边界研究

从理论角度阐述我国医保支付方式改革对医疗服务结果影响的作用机制,并分析医保支付方式在医改中的功能定位及该项改革工作在实现预期效果方面的有效前提。结果表明,支付方式改革可视作公立医院改革的重要抓手,但不是改革的核心。我国医保支付方式改革要实现预期目标,需要同时满足内外部多个传导前提:(1)区域内公共医疗保障程度需达到一定水平;(2)医疗服务供方的筹资体系相对处于封闭状态;(3)需要辅以取消药品加成政策;(4)需要与医院分配制度改革相衔接。按病种支付可以缓解当前医疗费用过快增长的压力,但无法从根本上避免公立医院的逐利倾向。同时改革过程中警惕异地就医可能带来的跨域性医保财政逆向转移的陷阱。     

Disability and dignity-enabling home environments

In Canada where long-term care is primarily oriented to elderly persons and affordable accessible housing is limited, younger disabled adults may be living in circumstances that do not meet their health needs and contribute to their social exclusion. The purpose of this study was to undertake an ethical analysis of what constitute an 'adequate' home environment for adults with significant mobility disabilities. An integrated design was used that combined qualitative interviews with normative ethical analysis in an iterative process. Twenty interviews with 19 participants were conducted in Ontario, Canada with two groups: younger adults (ages 18-55) with mobility disabilities and 'decision-makers' who consisted of policy makers, program administrators and discharge planners. Data were analyzed using a critical disability ethics approach and processes of reflective equilibrium. Drawing on Nora Jacobson's (Jacobson, 2009) taxonomy of dignity and pluralistic approaches to social justice, the concept of 'social dignity' provides a lens for exploring the adequacy of home environments for disabled people. Analyses suggested seven threshold conditions necessary for a dignity-enabling home: the ability to form and sustain meaningful relationships; access to community and civic life; access to control and flexibility of daily activities; access to opportunities for self-expression and identity affirmation; access to respectful relationships with attendants; access to opportunities to participate in school, work or leisure; access to physical, psychological and ontological security. The results have implications for housing, health and social care policies, and political reform. Social dignity provides a normative ethical grounding for assessing the adequacy of home environments. The threshold elements outline specific dignity-enabling conditions that are open to further specification or elaboration in different contexts.     

Assessing Community Health Among Indigenous Populations in Ecuador with a Participatory Approach: Implications for Health Reform

Health reform is an important movement in countries throughout the region of the Americas, which could profoundly influence how basic health services are provided and who receives them. Goals of health sector reform include to improve quality, correct inefficiencies, and reduce inequities in current systems. The latter may be especially important in countries with indigenous populations, which are thought to suffer from excess mortality and morbidity related to poverty. The purpose of this paper is to report the results of a community health assessment conducted in 26 indigenous communities in the Province of Cotopaxi in rural Ecuador. It is hoped that this information will inform the health reform movement by adding to the current understanding of the health and socioeconomic situation of indigenous populations in the region while emphasizing a participatory approach toward understanding the social forces impacting upon health. This approach may serve as a model for empowering people through collective action. Recommended health reform strategies include: 1) Develop a comprehensive plan for health improvement in conjunction with stakeholders in the general population, including representatives of minority groups; 2) Conduct research on the appropriate mix between traditional medicine, primary health care strategies, and high technology medical services in relation to the needs of the general population; 3) Train local health personnel and traditional healers in primary health care techniques; 4) Improve access to secondary and tertiary health services for indigenous populations in times of emergency; and 5) Advocate for intersectoral collaboration among government institutions as well as non-governmental organizations and the private sector.