卫生事业与卫生服务性质刍议

自从卫生经济学在我国创建以来,卫生工作者和卫生经济理论工作者都很重视对卫生事业性质的探讨。卫生事业的性质是卫生经济学的基本理论问题,如何理解卫生事业的性质,关系到我国医疗卫生单位经营方针和卫生事业经济管理体制改革方向,具有重大的理论意义和实践意义。笔者认为,要探讨卫生事业的性质,应该把卫生事业与卫生服务区分开来,卫生事业的性质与卫生服务的性质既有区别又有联系。卫生事业是卫生部门所从事的事业和括动,为社会提供卫生服务。卫生服务是医疗卫生单位的医务人员通过自己的劳动为社会及患者     

谈谈卫生事业的定性分析

任何事物都是质和量的统一体,卫生事业也不例外。10年来,在卫生经济问题的研究探讨中,既有对卫生事业质的规定性的定性分析,又有对卫生事业量的规定性的定量分析,而其中对卫生事业的定性分析,则始     

卫生管理队伍职业化是提高卫生管理的根本途径

卫生管理队伍职业化是是随着我国社会主义市场经济体制和卫生事业改革与发展的深化而提出来的一个重要的现实问题。认真研究并组织实施卫生管理队伍职业化对我国卫生事业持续、快速、健康发展和深化我国卫生事业改革具有十分重要的意义。     

大工业城市卫生事业发展的困境与出路

卫生事业的发展与社会经济的发展有着相互影响和制约关系。卫生事业的发展能促进经济发展和社会稳定,而经济发展的落后也会严重影响和限制卫生事业的发展。随着我国经济体制改革的不断深化,国营大中型企业出现的经济困境已成为社会性大问题。这些企业主要分布在我国大工业城市,是城市经济发展的主体,影响着城市的经济状况,也必然要制约着城市卫生事业的发展。 一、大工业城市卫生事业发展存在的主要问题     

运用系统科学和市场机制认识和发展卫生事业

这次卫生事业发展战略研讨会的中心议题是探讨如何建设具有中国特色的社会主义卫生事业。这是一个带有根本性的战略决策问题。为了提高决策的科学性和可行性,首先应该明确这样三点:第一,卫生事业在社会主义经济建设中的地位和作用;第二,卫生事业的性质及其发展的客观规律;第三,我国卫生事业的发展现状及存在的主要问题。只有明确了这三点,才能制订出既立足于现实,又指向未来的战略目标,并以一系列切实可行的措施作保证,使卫生事业和卫生经济建设朝着理     

我国卫生事业发展规律及其成因研究

借鉴国外卫生工作实践和理论研究成果,对我国卫生事业建设中的成功做法和经验进行探讨。对存在问题进行反思,从不同视野和角度总结出政府主导卫生规律等6务卫生事业发展的重要规律,并阐述其各自成因。结论认为,我国卫生事业发展是有规律可循的,卫生事业发展规律应随着实践的发展而不断总结和完善。     

城乡卫生资源分配不公的原因,影响及对策

城乡卫生资源分配不公,是我国卫生事业发展中存在的一个突出问题。这种状况的形成,既有历史的原因,又有市场经济发展的负面影响及国家宏观调控力度不够的原因。这一问题的存在,既影响卫生事业的顺利发展,又不利于社会的全面发展。解决这一问题,必须采取综合性的措施。     

关于我国农村卫生发展战略的理论思考

当前,我国卫生事业如同国民经济其它部门一样,正处在加快和深化改革时期。卫生工作如何跟上国家经济发展形势,服务于社会主义现代化建设,满足全国各族人民日益增长的健康需求,迫切需要科学的理论指导卫生事业发展。研究卫生事业发展,既要借鉴当今国际社会卫生发展的战略决策与经验,又要从我国实际情况出发,探索我国卫生事业的发展规律,从而确定符合我国国情的卫生发展战略。走出一条具有中国特色的社会主义卫生事业发展的路子,一条既能最切合我国国情,又能取得最经济、最能显效的路子。农村卫生和预防保健工     

对我国卫生资源配置和使用几个深层次问题的思索

我国卫生资源既分管又浪费成为业内人士的共识,但它又是一个困扰我国卫生事业发展的实际而又紧迫的问题,这个问题解决不了,就会降低我国卫生资源的使用效率。作者认为：要使我国有限的卫生资源以充分而合理地使用好,就要立足于我国的基本国情,在确保市场的微观调节的前提下,必须运用政府的宏观调控行为和政策指导手段,尽可能为管理体制的改革扫除障碍,同时在卫生资源的配置问题上引入法制机制。     

卫生事业性质之我见

关于我国卫生事业的性质,自80年代以来,是卫生管理学和卫生经济学界多次讨论的重大理论问题。经过几次全国性的热烈讨论,使人们对我国卫生事业性质的认识逐步深化,对推动我国卫生事业的改革和卫生事业管理的科学化、现代化都起了重大作用。为使我国卫生事业健康地发展,使今后卫生事业改革的路子更加符合我国的国情,有必要在以往讨论的基础上,继续深入地探讨这一重大理论问题,以期在基本问题上取得共识。这一问题的深入探讨,将对我国今后卫生事业改革、推行现代化科学管理,以及发展具有中国特色的卫生管理科学产生深远的影响。     

医疗保险模式对深圳市职工看病就医的影响分析

为了研究医疗保健模式对职工就知行为的影响，采用分层整群随机拉的方法对深圳市职工进行了调查分析，结果表明：实施医疗保险新模式，采用按平均费用标准偿付的支付方式，对职工看病就医的行为及卫生服务利用程度上都有很大的影响，职工两周就诊率和年住院率均高于１９９３年全国大城市平均水平，而年人均住院日与之比较则偏低。     

充分利用境外智力资源 创造对外合作美好前景——解放军总医院对外改革开放的回顾与展望

90年代以来,解放军总医院充分发挥自身的优势和潜力,进一步加快改革开放、对外交流合作的步伐,不失时机地利用境外智力资源,为医院现代化建设服务,使总医院的各方面建设发生了历史性的变化。文章论述了在新时期军队医院对外加强合作的必要性和可能性,认为充分利用境外智力资源是加快医院现代化建设的必要手段。只要在观念和体制上进行适当调整,就能有效地引进国际上最先进的科学技术成果和人才,在医院现代化建设方面收到事半功倍的效果。     

医疗人才培养适应社会需求的探讨

通过对南方地区医疗人才培养与社会需求状况的调研,从政府,用人单位及医学生个人三个层面,分析了形成总需求未满足而毕业生难求职这一现状的原因。认为医学院校除适时调整医学专业外,应从战略高度抓好在校生和职医生的素质教育,以适应卫生事业发展的需要。     

Patients’ Perspectives of Oral Healthcare Providers’ Communication: Considering the Impact of Message Source and Content

This study explores patients’ perceptions of positive and negative communication experiences with dentists and dental hygienists using a sample of 267 individuals who reported having a general dental provider. Patients’ oral health literacy, dental mistrust, use of dental health services, anxiety, and provider satisfaction are examined on the basis of reported communication experiences in the dental context. When comparing participants who had or had not experienced positive communication with a dentist, individuals with positive experiences demonstrated significantly higher levels of oral health literacy and provider satisfaction, as well as lower levels of dental mistrust. Participants who had experienced negative communication with a dentist reported significantly higher levels of anxiety and dental mistrust, as well as greater likelihood of ever leaving a dental practice, as compared to those without negative communication experiences. By contrast, positive and negative communication experiences with hygienists had limited impact on patient outcomes. Information derived from this investigation can be used by dental providers to guide communicative actions with patients, as well as by scholars to enhance existing theoretical explanations of the function of communication in dentistry.     

Informatics, imaging, and healthcare quality management: imaging quality improvement opportunities and lessons learned form HCFA's Health Care Quality Improvement Program

This article examines the use of population-based healthcare data at the interface among radiology, healthcare informatics, and health services research for the purposes of healthcare quality management. To illustrate these concepts, we draw on experience with Health Care Financing Administration's Medicare Health Care Quality Improvement Program (HCQIP). We present two HCQIP efforts that have identified opportunities to improve the delivery of imaging services, specifically studies of the diagnosis and management of congestive heart failure and cerebrovascular disease. The examples demonstrate from a population-level perspective that there are opportunities to enhance the quality of imaging practice by reducing the magnitude of imaging practice variability, implementing evidence-based guidelines, and optimizing the communication of imaging study findings to physicians who are responsible for subsequent diagnostic and therapeutic decisions. Additional research is required in specific clinical domains of radiology to determine if implementation of evidence-based imaging guidelines and enhanced clarity in the interpretation and communication of diagnostic imaging will improve health outcomes.     

对营利性与非营利性医疗机构界定的探讨

营利性、非营利性医疗机构的产生与发展及其特征以及如何界定和管理。     

Queensland extended care services for people with severe mental illness and the role of occupational therapy

Background:  People with serious mental illness in Queensland who require extended rehabilitation may be treated in extended inpatient mental health services. Two of these extended inpatient services, hospital and community-based 'Extended Treatment and Rehabilitation Units (ETRUs) and Community Care Units (CCUs)', are described, including the aims, objectives, philosophy and service delivery.
Methods:  A quality project involving occupational therapists working in these settings, as well as a consumer and carer, provides different perspectives concerning these relatively new health services in Queensland.
Results:  Two main occupational therapy roles were identified: case management and occupational therapy-specific roles (including assessment and intervention). The consumer and carer perspective is also presented.
Conclusion:  These services provide a positive option for people with high levels of functional disability as a result of mental illness and also for their carers. They provide environments with many exciting opportunities and challenges for occupational therapists working in mental health.     

Clinical practice, ethics and economics: the physician at the crossroads

In recent years health services have faced the challenge of increasingly complex services and rising costs, thus the consideration of costs is a key factor in health policy decisions. The introduction of an economic perspective has sometimes been viewed as conflicting with the ethics of the health care system, especially at the physician-patient level. this article explores the important role of the physician from the ethical and economic perspective in the distribution and allocation of services. An understanding of economic and ethical principles reveals that these two perspectives are compatible with good clinical practice: more efficient health care implies better care for the individual patient and makes it possible to increase the resources available to improve care for the population as a whole. Thus, being efficient is an ethical objective. The selective elimination of ineffective services would free resources to care for those who need effective diagnostic or therapeutic procedures. This requires a better understanding of the determinants and outcomes of clinical practice, physician motivation, the appropriate design and application of incentives, and the best use of limited resources. The physician can play a key role in increasing the efficiency, equity, and quality of the health system without restricting the provision of effective services.     

病人权利,义务在医疗实践中的保证

论述了病人权利和医疗法律法规中的地位,归纳了病人权利,义务的基本内容。在此基础提出了病人权利,义务在医疗实践中保证的措施,指出：医疗管理人员工作者要学习法律法规,医疗机构要建立必要可行的制度,使病人充分享有权利,履行应尽义务;医务人员要给予就医者足够的医疗信息,使其具有选择医疗方式的权利;在医疗实践中还应尽量满足就医者的特需请求。     

医院治理体制改革的创新思考

四中全会《决定》提出了建立法人治理体制的概念,这在国有企业改革攻坚上是新的突破,立意高远。医院管理既与企业经营存在共同的弊病,也面临着市场经济转轨和全面推行医保制度改革的外在压力,医院治理体制改革不容回避,同样期待着创新探索。应该建立医院法人治理体制,建成权力,决策、执行和监督四位一体的组织结构,形成权责明确,各负其责,协调运转,有效制衡的治理机制。采取“双向进入”的办法处理新老体制和行政党务体制