基本公共卫生经费按项目成本付费方式研究

为探索合理、有效的公共卫生经费补偿方案、提高经费使用效率,本研究以北京市丰台区为例,选取7个社区卫生服务中心,通过台账登记的方式收集成本测算的各项数据,并对各项目成本进行整理与测算分析。结果显示：开展基本公共卫生服务的人均服务成本为40元,当前的公共卫生服务经费标准应根据物价水平进行调整。建议公共卫生经费应在保证公共卫生服务正常开展的基础上,按照不同的公共卫生项目,通过绩效考核方式进行拨付,使公共卫生服务经费使用效率最大化。     

江苏省农村基本公共卫生服务政府购买现状实证研 究

目的对江苏省农村基本公共卫生服务政府购买现状进行研究,为保障基本公共卫生服务均等化进程的稳步推进提出合理化政策建议。方法采用现场问卷调查、关键知情人访谈、专题小组讨论、观察法开展研究。结果地方政府尚未完全履行筹资职责;服务和经费的层级分配不相符;财政补偿为主的购买方式难以适应卫生工作发展需要;考核方式存在不足;经费管理和使用缺乏具体指导意见。结论强化政府筹资职责;科学进行成本测算;合理安排基本公共卫生服务和经费的层级分配;健全考核和评估机制。     

基本公共卫生服务的补偿或支付标准国内外研究概况

目的:探讨国内外补偿标准,探究适应中国国情的基本公卫补偿机制,推动基本公卫服务健康有序发展.方法:通过文献学习法,罗列并分析当前国内外关于基本公卫服务补偿支付标准的利与弊.结果:基本公共卫生服务补偿标准有按照签约人头数向社区卫生服务机构以及家庭医生支付提供公共卫生服务的补偿费用;有少数按服务项目支付,按照服务项目的数量与质量进行补偿;也有部分基于时间收费来补偿.结论:基本公共卫生服务的补偿或支付标准的核算是国家基本公共卫生服务项目落实的起始也是极为关键的环节,它关系到政府对相关机构的基本公共卫生项目的经费投入与任务要求之间能否相适应.依据中国基层实情,有必要对基层实施的国家基本公共卫生服务项目成本进行测算,明确国家基本公共卫生服务项目成本现状、差距和经费投入需求,创新补偿标准机制.     

基于成本分析的成都市城乡基本公共卫生服务政策建议

目的:对成都市基层医疗卫生机构基本公共卫生服务项目进行成本测定,旨在为政府财政补助提供科学依据,为机构提高服务效率提供参考.对象:成都市社区卫生服务中心和乡镇卫生院样本机构共30所;方法:问卷调查法、观察法、时间系数分摊法;结果:各级政府财政对基本公共卫生服务项目人均补偿经费低于标准成本和实际成本;政策建议:机构应提高工作效率,政府适当增加财政补助,成本测算结果提示不宜增加基本公共卫生服务项目.     

成都市促进城乡基本公共卫生服务均等化的实施策略研究

分析成都市在推进城乡基本公共卫生服务均等化的实施策略及目前存在的问题和难点,提出进一步有效推进城乡基本公共卫生服务均等化的建议,即制定有财力保障的、体现均等化原则的基本公共卫生服务规划;测算基本公共卫生服务成本,增加公共卫生经费投入;保障流动人口有效地获得公共卫生服务;扩大基层公共卫生服务队伍,引入专业技术人员;进一步做好基层医疗卫生机构的公共卫生职能定位,将基层机构公共卫生考核和专业公卫机构工作结合。     

贫困地区农村基本公共卫生筹资现状

选择了3个样本县,对贫困地区农村基本公共卫生筹资现状进行了调查分析.结果显示:样本县各级财政对农村基本公共卫生的投入比重较高,但投入金额不足.建议:加大对贫困地区基本公共卫生服务专项经费的转移支付力度;规范财务管理,建立独立的基本公共卫生服务经费专户;以提高服务质量为契入点,提高经费的使用效益.     

省域基本公共卫生服务成本效果分析和TOPSIS法综合评价:以湖北省为例

目的:综合评价省域基本公共卫生服务项目绩效,对进一步完善基本公共卫生服务项目、科学合理评价项目执行状况提出可行的政策建议。方法:采用分层随机抽样,通过机构调查获取湖北省样本地区基本公共卫生服务信息系统数据资料;通过查询政府网站获取相关政策文件;通过专家咨询筛选评价指标,并结合层次分析法确定各指标权重,同时分别运用成本效果分析和加权TOPSIS法,纵向和横向比较评价样本地区基本公共卫生服务项目绩效。结果:实际人均项目补助标准偏低;部分项目成本效果有所改善,尤其是慢性病患者规范化健康管理;各县区基本公共卫生服务项目绩效差异较大,Ci值最高为0.781 1,最低仅为0.269 4。结论与建议:将流动人口纳入基本公共卫生服务经费预算范围,建立动态增长机制;优化基本公共卫生服务绩效考核方案,综合运用成本效果分析和TOPSIS法,通过纵向和横向分析相结合的方法,克服单一方法不足;加大财政投入,推进基层医疗卫生服务体系建设。     

山西省某县基本公共卫生服务专项经费管理的调查与思考

目的研究山西省某县基本公共卫生服务专项经费的拨付、补偿和使用情况,为县域内该专项经费的管理提供理论支持和实践经验。方法采用半结构式访谈法,并查阅相关机构数据和文献,以定性研究为主,分析该县基本公共卫生服务专项经费管理的优势和弊端,并提出改进的建议。结果该县基本公共卫生服务专项经费拨付和成本测算较科学合理,但经费支出中人员补助和耗材费用比例失调,补偿机制不利于调动各参与方的积极性,经费使用细节上也存在改善空间。结论调整专项经费的拨付制度和拨付标准,合理分配经费,有效激励各参与方,并规范服务成本的测算,进而提高基本公共卫生服务质量。     

浙江省县域内基本公共卫生服务的成本差异及补偿研究

目的:核算浙江省县域范围内基本公共卫生服务成本,探索有效的补偿模式。方法:以浙江省金华东阳县域内5个不同经济发展水平和公共卫生服务能力乡镇(街道)为样本县,采取现场调查、成本分析等方法,对公共卫生服务3大类12项内容开展了成本测算。结果:样本县2010年乡镇基本公共卫生服务成本为34.95元/人,不同地区间因经济水平、服务人口中流动人口比例、兼职公共卫生工作人员等不同而存在差异。结论:建议能继续加大财政对基本公共卫生投入,尤其是建立涵盖流动人口的经费投入标准,并建立有效的考核与补偿机制,同时加强人员队伍建设,以确保公共卫生服务的质量与效率。     

流动老人基本公共卫生服务利用及影响因素研究

目的:了解流动老人基本公共卫生服务利用情况及其影响因素,为促进公共卫生服务均等化提供数据支持。方法:以安德森卫生服务利用模型为理论基础,使用2015年全国流动人口动态监测数据,结合深度访谈,对影响流动老人卫生服务利用的人群特征及环境因素进行分析。结果:流动老人基本公共卫生服务利用率偏低并在群体内存在差异;户籍类型、居住时长、流动范围是影响流动老人卫生服务利用的主要因素;基层卫生服务机构存在经费拨付与工作量不一致、数据不清、工作不被理解等方面的困难。结论:流动老人基本公共卫生服务可及性较差、健康意识薄弱,应加强健康教育宣传;对农村户籍、居住时间短和流动跨度大的老人给予重点关注;卫生部门应加强针对流动老人的数据统计,改变基本公共卫生服务经费拨付方式,优化信息化建设顶层设计,促进流动老人基本公共卫生服务利用。     

The role of the schools of public health in the development of primary health care

Starting with the assumption that the schools of public health can and should be major promoters of primary health care but that they have not fully utilized their potential, the paper reviews the different interpretations of primary health care and their implications for the recruitment policies, educational objectives, teaching methods and research orientation of the schools. Four interpretations (primary health care as a set of activities; as a level of care; as a strategy of organizing health services; and as a philosophy permeating the entire health care system) are identified. It is suggested that most industrialized countries already have a primary medical care system which has to be transformed into primary health care. A blueprint for this transformation is outlined. Many of the changes included in the blueprint are related to the concept of primary health care as a strategy. Schools of public health can play a major role in implementing the necessary strategic changes and in training their implementers. The training of actual primary care providers for leadership; increased emphasis on management in the curricula; and reorientation of research towards primary health care are underlined as particularly important elements in the new role of the schools of public health.     

后SARS时期的公共卫生政策发展

SARS直接冲击了现有的公共卫生政策，暴露出我国公共卫生服务存在的种种问题。由于现行的公共卫生政策已不能适应市场经济的要求，公共卫生应引入公共管理的理念，重新界定公共卫生要迫切解决的问题，科学地制定适时、有效的公共卫生政策，以促进公共卫生服务的发展。     

Public Health Renaissance and the Role of Schools of Public Health

In these turbulent times of political, social and economic changesin Europe public health is again coming into focus. Schoolsof public health, for long the basis for education of publichealth leaders will also in the future play a key role in promotingthe ‘new’ public health agenda. Based on ecologicalawareness and public involvement in health their teaching, researchand policy development should make them be seen as Centres ofRelevance and not only as Centres of Excellence, thus gearingtheir activities to the needs of new generations of practitionerswho can be both activists and advocates for health. If trainingand research are made relevant for practice and community service,then schools will be in the centre of public health insteadof in the periphery of medicine. Elements of a strategy to achievethese objectives are discussed.     

我国财政体制对公共卫生补偿政策的影响

新的财政体制在我国已经施行了整整10年。在这10年里，我国的公共卫生补偿政策出现了哪些变化，新的财政体制到底对我国的公共卫生补偿政策产生了什么样的影响以及今后我国对公共卫生补偿的改革方向是什么样的，是本文想要阐述的主题。     

河南省城乡居民接受基本公共卫生服务现状与需求分析

目的了解河南省城乡居民接受基本公共卫生服务的现状及居民对公共卫生服务的需求,为政策制定提供依据。方法应用现况调查的研究方法,对4个地市的499名城乡居民进行问卷调查的填写,其中城市居民251名,农村居民248名。同时与市、县（区）卫生行政部门21人、疾病预防控制机构人员22人、基层卫生服务机构人员13人进行深入访谈。结果城乡居民基本情况客观上存在差别,包括文化程度、医疗保障制度及家庭经济情况。接受基本公共卫生服务的可及性及现状也不同,疾病负担及其他多种因素导致需求有所不同。结论河南省基本公共卫生服务已经起步,服务接受情况存在城乡差别,尚不能满足城乡居民需求。     

The Demise of Artificial Trans Fat: A History of a Public Health Achievement

Policy Points

• This article describes a strategic combination of research, advocacy, corporate campaigns, communications, grassroots mobilization, legislation, regulatory actions, and litigation against companies and government to secure a national policy to remove artificial trans fat from the US food system.
• Sharing lessons we learned can help inform policymakers, academics, policy practitioners, and students across disciplines. Some of our lessons are that system change means that all consumers benefit without the need for individual behavior change; research can both identify opportunities to improve health and support policy adoption; policy efforts can serve as public education campaigns; policy campaigns can drive marketplace changes; and engaging forward‐thinking companies can diffuse opposition to passing a policy.

ContextFor many decades, partially hydrogenated vegetable oil (PHO), the primary source of artificial trans fat in the American diet, was used widely in processed and restaurant foods. In the early 1990s, studies linked the consumption of artificial trans fat with heart disease. This article details how research and advocacy led to eliminating artificial trans fat from the US food supply.MethodsWe synthesized published studies of the health impact of trans fat, the legislative history of state and local trans fat bills, the Food and Drug Administration''s (FDA) regulatory docket on trans fat labeling and its declaration that PHOs are no longer Generally Recognized as Safe (GRAS), and our own files, which included strategy documents, notes from meetings with the FDA staff, correspondence between advocates and the FDA, fact sheets, press releases, news clips, and other materials.FindingsThis history of trans fat provides insights into policy strategy and advocacy best practices that resulted in the removal of trans fat from food in the United States, preventing an estimated 50,000 premature deaths a year. The lessons we learned are that system change benefits all consumers without the need for individual behavior change; research can both identify opportunities to improve health through policy and support policy adoption; policy campaigns can serve as public education campaigns; policy can drive changes to products and the marketplace; and engaging forward‐thinking companies can help diffuse opposition to passing a policy. Securing this policy required the persistence of scientists and health advocates in first discovering the risks and then using the science to secure policies to mitigate the identified harm.ConclusionsAn understanding of the tactics used to help attain the targeted policies and how challenges were addressed (such as through communications, leveraging an expanding research base and expert reports, showing that a national policy was feasible through voluntary corporate changes and state and local policy, and litigation against companies and government agencies) may provide a model for scientists, students, advocates, and policymakers. We hope this account will inform efforts to address other public health challenges, such as the current threats of excessive exposure to sodium and added sugars, which persist in the US food system.     

Public Participation in the Process of Local Public Health Policy,Using Policy Network Analysis

Objectives:

To assess the current public participation in-local health policy and its implications through the analysis of policy networks in health center programs.

Methods:

We examined the decision-making process in sub-health center installations and the implementation process in metabolic syndrome management program cases in two districts (‘gu’s) of Seoul. Participants of the policy network were selected by the snowballing method and completed self-administered questionnaires. Actors, the interactions among actors, and the characteristics of the network were analyzed by Netminer.

Results:

The results showed that the public is not yet actively participating in the local public health policy processes of decision-making and implementation. In the decision-making process, most of the network actors were in the public sector, while the private sector was a minor actor and participated in only a limited number of issues after the major decisions were made. In the implementation process, the program was led by the health center, while other actors participated passively.

Conclusions:

Public participation in Korean public health policy is not yet well activated. Preliminary discussions with various stakeholders, including civil society, are needed before making important local public health policy decisions. In addition, efforts to include local institutions and residents in the implementation process with the public officials are necessary to improve the situation.     

Communities of solution: the Folsom Report revisited

Efforts to address the current fragmented US health care structure, including controversial federal reform, cannot succeed without a reinvigoration of community-centered health systems. A blueprint for systematic implementation of community services exists in the 1967 Folsom Report--calling for "communities of solution." We propose an updated vision of the Folsom Report for integrated and effective services, incorporating the principles of community-oriented primary care. The 21st century primary care physician must be a true public health professional, forming partnerships and assisting data sharing with community organizations to facilitate healthy changes. Current policy reform efforts should build upon Folsom Report's goal of transforming personal and population health.     

基层卫生服务机构支付方式研究

基层卫生服务机构是基本卫生服务的提供主体,对基层卫生服务机构支付方式的改革牵动着筹资、卫生服务提供的质量和效率、结果的公平性等多方面的问题,是卫生改革的重点。从概念上界定了基层卫生服务机构和支付方式,而后对相关文献进行了研究总结。对基层卫生服务机构支付方式的研究,多从财政补偿力度的角度,论证了对基层的投入不足和一些对具体到某一种服务的支付方式的探讨。尚无文献从支付方式理论出发,对基层卫生服务机构的支付方式和配套政策进行系统的研究。文献中提出的政策建议,以强调政府职责为主,对支付方式的选择以及配套政策给予建议性的研究。