Beyond access: extending our thinking on health policy

Expanding access is often seen as a panacea for health problems. Although access is a necessary step, it is also important that policy analysts do not fail to consider postaccess issues. Increased access to health is often assumed to be synonymous with improved health outcomes; however, just because access exists does not mean (1) that everyone will take advantage of access to resources or (2) that those taking advantage of access will necessarily see improved outcomes. This article focuses on three aspects of health policy, (1) the types of postaccess issues that exist, (2) the "if you build it, they will come" syndrome, and (3) updating the Anderson/Aday model of health care access to better theoretically understand postaccess issues.     

我国健康管理的现状与思考

健康是人全面发展的基础,医疗卫生事业关系千家万户幸福,是重大民生问题。疾病谱的变化、居民健康意识的提高,使得居民健康需求不断增长。开展基于控制疾病费用和提高全民健康素质、贯彻预防为主方针的健康管理意义重大,是实现人人享有基本医疗卫生服务、促进公共卫生服务均等化的重要途径。     

1882例慢性心力衰竭患者药物治疗动态分析

目的观察1882例慢性心力衰竭患者药物治疗动态,分析用药合理性.方法采用1998年、2001年和2004年住院慢性心力衰竭患者病历数据库,对1882例慢性心力衰竭患者使用药物治疗状况进行调查分析.结果1882例患者在1998年、2001年和2004年药物使用率分别是利尿剂63.7%;68.1%;74.5%、洋地黄类40.2%;42.4%;67.9%、血管紧张素转换酶抑制剂/血管紧张素受体拮抗剂(ACEI/ARB)18.2%;30.3%;57.1%、β受体阻滞剂(β-blocker)14.9%;31.2%;60.1%、硝酸盐类42.5%;48.2%;56.3%、非洋地黄类正性肌力药物25.7%;28.9%;20.7%、钙离子拮抗剂17.5%;18.3%;20.1%.未考虑使用β-blocker占不用原因的32.6%,未考虑使用ACEI/ARB占不用原因的34.6%.结论提示自心力衰竭治疗指南公布以来,对临床医生确有指导作用,使慢性心力衰竭规范化药物治疗水平有了明显提高.     

中国农村医疗卫生事业的回顾与思考

新中国成立后，在党和政府的艰苦努力下，我国农村卫生事业蓬勃发展，取得了举世瞩目的伟大成就。建国初期，我国政府致力于农村卫生保健网的建立和完善，到1965年初步形成了以集体经济为依托的农村初级医疗卫生保健网，但是，1979年以后，农村经济体制改革使村级卫生组织失去了“集体经济”的依托，村卫生室纷纷改变了所有制形式、经营方式和服务方向；     

Critical thinking in health care supervision

Henry Ford is reputed to have said that thinking is the hardest work there is, which is probably why so few people engage in it. Perhaps many people have felt this way sometimes, especially when they viewed the foibles of the human race displayed prominently on the evening television news. Some people do stupid things; some people seem to be mindless in what they do. This applies also to some in managerial and supervisory positions in health care organizations. The percentage of these thoughtless managers and supervisors is probably comparable to the percentage of the thoughtless people in the general population. Fortunately every normal functioning human being is capable of becoming a more critical thinker. Of course, no amount of effort is adequate to the development of critical thinking when a person lacks fundamental good sense. On the other hand, no amount of genius suffices when someone does not put forth adequate effort to become a more critical thinker.     

New perspectives on our national health care dilemma

Continued debate over who should pay for the increasingly unaffordable U.S. health care system has failed to yield a consensus solution. Shifting attention to how to reduce health care costs may be more productive. Strategies for achieving this goal include drastically reducing costly quality deficiencies, eliminating higher cost care options that add no demonstrated value, recognizing that responsibility for clinical and cost consequences cannot be divided, and acknowledging that rationing available resources is superior to other allocation alternatives.     

医疗保障制度改革对医院的影响

该文根据云南省曲靖市1997年实施医疗保障制度、改革医疗市场供求关系发生的变化、医院运营情况(包括医疗服务量、医疗效率、业务收入、医疗费用等)、医院经济效益等方面的具体情况,结合翔实的数据,就医改运行对医院的影响进行了比较分析。     

我国医疗成本核算研究进展与思考

一、我国医疗成本核算研究进展 1.医疗成本测算方法逐渐完善 在我国,卫生服务成本测算方法从20世纪80年代中期开始发展应用起来.1985年7月,卫生部、财政部、国家物价局联合发出《关于进行医疗成本调查的通知》,成立联合调查组,调查了吉林、山东、甘肃三省的医疗成本与收费.复旦大学公共卫生学院（原上海医科大学公共卫生学院）于1987年开展了上海医院成本核算方法和应用研究,1990年又对全国10个城市25所医院进行了成本核算方法、成本标准化管理及病种成本研究.山东省卫生厅于1994年对132种代表项目进行了成本核算,并提出了医疗服务项目成本的指数推测方法.1996年卫生部卫生经济研究所在山东成立了成本测算中心,并对11省（市）33所医院医疗服务成本进行了测算和分析.单病种成本核算方法主要有两种：历史成本法和标准成本法,主要用于制定按病种收费的价格以及评价病种收费的合理程度.目前,我国医院基本上实行按医疗项目收费制度,但随着医疗保险制度的逐步实施,一些地区和医院正在尝试开展医疗项目成本核算和病种成本核算,加强医疗项目和病种的成本管理.     

Families in the 1980s: time to refocus our thinking

The prevailing image of the family is based on the notion that although the family is changing in certain peripheral respects, it maintains a great deal of fundamental or core continuity as well. There is a small but steadily growing number of researchers and practitioners who, for a variety of theoretical and empirical reasons, are uncomfortable with the validity of the prevailing paradigm and are asking whether it is time for a fresh image of the family. Scanzoni examines the state of American families in the 1980s in the light of a series of issues regarding the paradigm currently prevailing within family studies. He asks the following questions to identify some of the blinders limiting reality; the concerns addressed provide a sketch of the beginnings of an alternative family paradigm. 1) Are the purposes of marriage/family best expressed in term of rights, duties, and obligations? 2) How widespread is the variability in expectations for duty and freedom in marriage and family relationships? 3) Are the ingredients of relationships more meaningful than such labels as legal marriage and conjugal family? 4) What is the social meaning of the marriage license? 5)How valid is it to retain the conjugal family as the benchmark? 6) Do the notions of child/adult/relationship development need rethinking? 7) Is a more generalizing construct than marriage/family needed? 8) How should different types of situations be distinguished? 9) Has evolution of institutions such as marriage ceased? 10) Is permanence prized for its own sake or is it a net effect? The question is raised as to whether or not an alternative perspective might more validly describe currently emerging family-type empirical realities.     

A need to expand our thinking about "repeat" abortions

BackgroundWomen who have more than one abortion are often the “targets” for social and clinical interventions geared at preventing “repeat abortions.” Such an approach ignores the unique circumstances that may surround each abortion.Study DesignWe qualitatively analyzed the history of 10 women who have had more than one abortion who were participating in a larger study of women's emotional experiences following abortion. Women were recruited following their initial contact with a postabortion support talk line and from a previously completed study.ResultsOverall, women in the sample reported that each abortion was different and some abortions were more emotionally difficult than others, suggesting that the phrase “repeat” can be a misnomer and discounts the unique circumstances surrounding each abortion.ConclusionRather than use the term “repeat abortions,” we advocate for the use of the less loaded term “multiple abortions,” in which each abortion is understood as a unique experience.