巴西卫生部门权力下放政策评析

巴西将进行的卫生改革，促成了该国一体化卫生系统（UHS），权力下放是巴西卫生改革的一个重要原则，把责任和资源转移给地方政府——市政府。改革按市的级别进行，并按1996年的基本操作法（BOR）筹集基金。以下介绍有关权力下放政策的形成过程、权力下放方案、以及下放结果三个关键问题，进行一些分析。     

学习企业管理经验 办好医疗卫生事业

我国卫生管理体制改革,也和经济体制改革一样,是从扩大卫生单位的自主权开始的。从它的上级主管部门看,是把权力下放给卫生单位。上级主管部门作为国家机关,是全民所有制卫生单位的财产所有者,卫生单位是直接从事卫生服务活动的经营者。为了使它的经营活动能有效地进行,把部分权力下放给它,也就意味着所有权和经营权的分离。当然,在改革初期,人们未必都能从这样的理论高度来认识放权和扩权问题。《中共中央关于经济体制改革的决定》中指出:“根据马克思主义的理论和社会主义的实践,所有权同经营权是可以适当分开的。”这不仅精辟     

权力下放过程中人事制度改革对卫生人力素质与结构的影响研究

为了解权力下放过程中人事制度改革措施对中国农村卫生人力的影响，采用定性与定量相结合的方法在福建省某地区的两个县开展研究。结果发现：人事制度改革政策有利于扩大医院及院长的自主权，但许多改革措施难以贯彻落实；卫生人员的录用机制有所改善，但人员调动及解聘仍存在障碍，且人才流失难以遏制，权力下放政策实施后，卫生人力的数量，素质，结构有所改善。     

权力下放对乡镇卫生院卫生人力资源管理的影响研究

该文旨在了解卫生管理权力下放对乡镇卫生院卫生人力资源管理的影响。采用定性与定量相结合的方法在福建省某地区的两个县开展研究。结果表明 :实施卫生管理权力下放后 ,乡镇卫生院在人员录用、解聘及调动等方面拥有了更大的自主权 ;卫技人员参加在职培训的机会增多 ,但对预防保健人员的培训有所忽略 ;另外 ,新的薪酬制度虽然提高了卫生人员的积极性和收入 ,但在医疗费用和服务质量等方面出现了一些负面效应     

乡镇卫生院体制改革探讨

乡镇卫生院体制改革,首先必须转变县卫生局职能,从办卫生到管卫生,对乡镇卫生院主要是任命院长,制订和考核 年度医疗卫生工作目标,其它权力下放.乡镇卫生院内部改革主要是明确产权关系,健全法人权利,完善监督制约 机制,让职工成为单位主人.结果:乡镇卫生院成为国家和职工共同所有的股份合作制实体.在完成国家赋予的公 共卫生工作的同时,发展基层医疗服务.职工推选院委会,作为经营管理者;确定监事会,监督院委会工作.从而确 保国有资产保值、增值,乡镇卫生院不断发展.     

华东卫生经济研究协作会第十六次年会征文通知

经研究决定 ,华东卫生经济研究协作会第十六次年会将于２０００年１０月在江西省井冈山市召开。现将征文内容通知如下 :会议主题 :新世纪卫生改革发展的趋向。征文内容 :１．城市医疗机构管理体制与运行机制改革研究 ;２．社区卫生服务及区域卫生规划研究 ;３．卫生资源配置研究 ;４．卫生机构的人事制度、分配制度改革研究 ;５．进一步落实和完善农村卫生经济政策研究 ;６．建立农民健康保险制度的原则与有效形式 ;７．卫生财务管理如何适应卫生改革发展的需要 ;８．其它与卫生改革、发展有关的研究。请各省、市卫生经济学会组织征文 ,并从…     

从一个英国医院集团的运营现状看医院集团的发展趋势

当前我国城市大型医疗机构的集团化发展是一个不可阻挡的趋势[1 4 ] 。在其发展过程中 ,借鉴和学习国外的医院集团运作方法 ,正确运用到卫生改革的实践中是医院管理者研究的重要课题。作者结合中国卫生经济网络“旗舰”培训计划所采用的英国伦敦Ｓｍｉｔｈ医院托拉斯 (下文中称集团 )的资料[5] ,分析其运作的主要方法和成败得失 ,探讨在当前形式下有借鉴作用的医院集团化管理模式。一、医院集团基本情况2 0世纪 90年代中期 ,英国卫生行政管理部门(ＮＨＳ)为了提高医院经营效率 ,推动医院之间的竞争 ,采取了一系列有利于医疗机构权力下放的管…     

权力下放与社区卫生服务发展的思考

社区卫生服务是城市居民基本卫生服务的最佳方式,对于改善医疗卫生服务的公平性,满足社区居民的医疗保健需求,在提供便捷、综合、协调、价廉的卫生服务方面具有很大优势;在提高医疗卫生服务效率,控制医疗费用过快增长等方面起到了卓有成效的作用。作者结合参加上海市社区卫生服务的改革发展经验,从理论和实践上探讨社区卫生服务发展的问题和权力下放改革模式在社区卫生服务实践中的作用,并介绍委托管理改革的实践和效果。1问题1.1产权制度模糊创新能力受限虽然社区卫生服务中心的自主权有所扩大,管理经营权、人事权、分配权等得到了一定程度…     

英国国家卫生服务的改革（上）

本文概述了英国国家卫生服务的改革情况。１９９０年卫生改革鼓励通过内部市场运转，将权力下放至地方供求单位。另一方面，完善和修改了监督与责任机制，颁布、实施了加强中央管理体制等多项措施以相互约束。但由于面临不断增长的医疗保健需求，使该国卫生服务矛盾及政策上的冲突更加严重。本文概述了英国卫生服务的改革情况，分析、探讨了该国卫生服务工作在改革中所面临的一些矛盾和问题。     

卫生产业是重要的卫生资源

兴办卫生产业是筹集卫生资金的一种形式，一个渠道。几年来，青浦县卫生系统在兴办卫生产业方面取得了一些成绩，为卫生改革和发展作了一些贡献。     

Federalist flirtations: the politics and execution of health services decentralization for the uninsured population in Mexico, 1985-1995

Around the world health services delivery systems are undergoing decentralization, responding to pressure to increase equity, efficiency, participation, intersectoral collaboration and accountability. This study examines the Mexican health decentralization efforts of the past decade to discern the motivations for the reform, the context for its implementation, the politics of its downfall, and the reform's impact at subnational levels of government. Sparked by economic crisis and pressure from international creditors for fiscal reform; demands for greater democracy, equity, and quality; and technocratic impulses to rationalize health services delivery, the decentralization reform could not overcome the authoritarian centralism of the federal government and its corporatist clients. In the end, even in the most technically capable states, the reform was unable to overcome political obstacles to decentralizing fiscal power, redistributing resources in an equitable fashion, and eliminating the inefficiencies of separate but unequal health systems for social security recipients and the uninsured population.     

政府卫生支出健康效率测算及分析

目的：测算和分析中国1990年、2000年和2010年政府卫生支出的健康效率及其影响因素。方法：运用DEA和Tobit测算政府卫生支出的健康效率,评估效率值的影响因素。结果：政府卫生支出的健康生产效率在波动中有所提高,不同年度处于前沿面的省份基本一致,远离前沿面的省份存在较大差别;该效率在各区域间的差异较显著,东部地区政府卫生支出的健康生产效率高于中、西部地区;财政分权与政府卫生支出健康效率存在显著负相关关系。结论：财政分权制度的改革与完善是提高政府卫生支出健康效率的重要途径。     

Key issues relating to decentralization at the provincial level of health management in Cambodia

The following study was conducted as part of a review of management systems at a Provincial Health Department (Kampong Cham Province) and a National Health Programme (National Immunization Program) in 2002-2003 in Cambodia. The aim of this paper is to identify, analyse and recommend those management system factors that are critical to the success of health management performance, with a particular focus on provincial management. The review has identified critical success factors associated with health management performance at the sub-national level that include a stronger role for effective human resource management in health sector reform, elevation of the status of planning in senior level management, and the development of a more comprehensive and transparent finance system. These success factors will position the provincial level of health management to respond more effectively to the reform challenges of administrative de-concentration and political decentralization that are currently underway across a range of government sectors in Cambodia.     

推进医改五项重点工作中的难点问题——部分地市卫生主管领导调查

目的:通过调查分析部分地市级卫生主管领导在推进医改五项重点工作中存在的困难和问题,及时总结经验,为进一步推进医改工作提供借鉴。方法:对34名地市级卫生主管领导进行问卷调查和访谈,并将所收集的信息进行统计分析和综合归纳。结果和讨论:通过对地方推进五项重点改革工作面临的困难和问题进行重要性排序,可以发现:(1)基本医疗保障制度推进迅速,但存在后续资金不足和资金管理方面的问题;(2)基层医疗卫生服务体系建设成效显著,但人才匮乏成为主要问题;(3)基本公共卫生服务均等化需要进一步制度化、规范化;(4)基本药物制度大有可为,但需集中攻破难点问题;(5)公立医院改革的方向和路径尚不清晰。政策建议:(1)持续、稳定、合理的投入机制是进一步推进改革的基本保证;(2)鼓励地方积极探索,自下而上地探索转化机制的适宜方式;(3)基本药物制度基本确立了综合改革、统筹推进的思路;(4)公立医院改革实践要从统一基本认识出发;(5)重点领域的医改政策解读和研究应更深入和有针对性。     

对当前医改进展及相关问题的认知分析——部分地市卫生主管领导调查

目的:了解地市级卫生主管领导对医疗卫生事业和医改工作的态度和观点,从而判断形势、发现问题,更好地推进医改工作。方法:对来自29个省市的34名地市级卫生主管领导进行了结构式和半结构式的问卷调查和小组访谈。结果:(1)地市级卫生主管领导对卫生事业的基本规律和医改的主要目标理解正确、掌握清楚,但对"管办分开"的内涵和公立医院功能定位等仍存在模糊认识;(2)目前推进医改工作中的主要障碍为管理体制分散,资金投入数量不足、结构不合理,以及地方政府财政压力较大等;(3)地方领导认为理顺管理体制,建立长效、制度化的补偿机制和不同层级间的分担机制是未来医改亟需解决的问题,同时要加强对现有基层卫生人员的培训,从而完善人才队伍建设。     

Proposals to reform the U.S. health care system: a critical review.

The objective is to provide an overview and analysis of the current discussion of ways to reform the U.S. health care system. A common analytic framework is needed to evaluate the alternative approaches that are being advocated. Such a framework, organized around seven general questions, is developed and discussed. The analytic framework is then applied to five specific reform proposals, selected to be representative of the range of options being considered. The results are used to identify the basic choices that are inherent in the current discussion of health system reform. A discussion of the political realities of the health system reform movement in the U.S. concludes that an incremental reform measure will be implemented at the federal level in the near future and that the reform measure will give the federal government increased control over the health care sector. However, the pressure for more fundamental reform will continue to grow.     

Winning Hearts and Minds: Using Psychology to Promote Voluntary Organ Donation

Recent psychological research concerning determinantsof and barriers to organ donation is reviewed with theintention of ascertaining acceptable and potentiallyeffective ways of improving organ retrieval. On thebasis of this review, five recommendations are made.(1) Individuals' donation wishes, where explicit,should be decisive. (2) Next of kin should witnessdonor decisions. (3) Mandated choice should replacevoluntary `opting-in'. (4) Initial donation choicesshould be repeatedly re-evaluated. (5) Those involvedin organ procurement should distance themselves frommodel of bodies as machines or gardens and embracemodels where bodies are viewed as sacred extensions ofself. In combination, these recommendations are arguedto be preferable in several ways to opt-out/presumedconsent procurement options.     

过度市场化与分权化--中国医疗卫生改革的双重误区

改革开放以来,我国经济状况不断向好,卫生费用增长很快,然而卫生绩效却不容乐观.本文认为,卫生领域的过度市场化、分权化是问题的主要根源.因此,建议确立卫生支出的政府主导地位,特别要强化中央财政的支出责任,建立不同层级政府间规范的责任分担与资金筹集机制.     

Centralizing and decentralizing governance in the COVID-19 pandemic: The politics of credit and blame

COVID-19 led to significant and dynamic shifts in power relations within and between governments, teaching us how governments make health policies and how health crises affect government. We focus on centralization and decentralization within and between governments: within government, meaning the extent to which the head of government controls policy; and between governments, meaning the extent to which the central government pre-empts or controls local and regional government. Political science literature suggests that shifting patterns of centralization and decentralization can be explained by leading politicians' efforts to gain credit for popular actions and outcomes and deflect blame for unpopular ones. We test this hypothesis in two ways: by coding the Health Systems Response Monitor's data on government responses, and through case studies of the governance of COVID-19 in Austria, Czechia and France. We find that credit and blame do substantially explain the timing and direction of changes in centralization and decentralization. In the first wave, spring 2020, heads of government centralized and raised their profile in order to gain credit for decisive action, but they subsequently tried to decentralize in order to avoid blame for repeated restrictions on life or surges of infection. These findings should shape advice on governance for pandemic response     

Protecting resources for primary health care under fiscal federalism: options for resource allocation

The introduction of fiscal federalism or decentralization of functions to lower levels of government is a reform not done primarily with health sector concerns. A major concern for the health sector is that devolution of expenditure responsibilities to sub-national levels of government can adversely affect the equitable distribution of financial resources across local jurisdictions. Since the adoption of fiscal federalism in South Africa, progress towards achieving a more equitable distribution of public sector health resources (financial) has slowed down considerably. This study attempts to identify appropriate resource allocation mechanisms under the current South African fiscal federal system that could be employed to promote equity in primary health care (PHC) allocations across provinces and districts. The study uses data from interviews with government officials involved in the budgeting and resource allocation process for PHC, literature on fiscal federalism and literature on international experience to inform analysis and recommendations. The results from the study identify historical incremental budgeting, weak managerial capacity at lower levels of government, poor accounting of PHC expenditure, and lack of protection for PHC funds as constraints to the realization of a more equitable distribution of PHC allocations. Based on interview data, no one resource allocation mechanism received unanimous support from stakeholders. However, the study highlights the particularly high level of autonomy enjoyed by provincial governments with regards to decision making for allocations to health and PHC services as the major constraint to achieving a more equitable distribution of PHC resources. The national government needs to have more involvement in decision making for resource allocation to PHC services if significant progress towards equity is to be achieved.