定量论证城市疾病防制功能以以切实落实状况

运用我国大、中、小城市疾病防制机构总体数据模拟论证“我国防制功能难以切实落实的作用机制定量模型”,发现80年代以来,我国城市疾病防制机构财政投入相对其所开展的无偿服务呈现财政投入萎缩,疾病防制机构有偿服务支出占疾病防制机构业务支出的比重呈现增加趋势;扣除物价因素影响后,1997年与1986年相比,有偿服务膨胀的财政责任明显大于防疫机构疾病防制机构自身责任。与全国总体相比,城市防疫机构疾病防制机构有偿服务膨胀归因于自身责任比重更大。     

社会互动:疾病防制功能难以落实作用机制模型的逻辑推论

该文依据卫生系统宏观模型思路,应用层次分析法,逻辑推论了疾病防制系统焦点问题(疾病防制功能难以切实落实到位)的直接相关因素和间接促发因素,认为问题的起始根源是政府对公共产品提供机构的财政投入不足,致使疾病防制功能中无偿服务部分缺乏激励监督,同时为了弥补财政投入的不足政府不得不允许疾病防制机构提供部分“有偿服务“但缺乏有效的规范和制约,导致功能偏废(重有偿轻无偿),部分缺乏收益的疾病防制功能难以切实落实.并总结和建立了焦点问题的作用机制模型-“社会互动:我国疾病防制功能难以切实落实到位作用机制模型“.在此基础上,推论了农村三级卫生网及其组织的变化对农村疾病防制功能落实的影响.     

运用全国疾病防制机构数据模拟论证疾病防制功能难以切实落实模型

运用全国疾病防制机构总体数据模拟论证“我国疾病防制功能难以切实 落实作用的机制定量模型”,发现1997年全国疾病防制机构财政投入相对其开展的无偿服务缺口为37．6万元－47．4万元,从80年代以来,疾病防制机构有偿服务支出占其业务支出比重呈现增加趋势,1997年达0．48％－0．53％。扣除物价因素影响,1997年与1986年相比,有偿服务收入膨胀的财政责任为77．00％－86．10％,疾病防制机构自身责任为13．90％－23．00％。     

我国疾病防制功能难以切实落实的作用机制定量模型

旨在提供一套比较完善的公式方法,以定量表达“我国疾病防制功能难以切实落实的作用机制模型”的逻辑关系,对疾病防制机构财政投入不足的严重程度和对有偿服务的重视程度进行定量确定,并对有偿服务收入膨胀的各方责任进行分析。     

农村疾病防制机构面临的问题及对策

目的 了解农村疾病防制机构面临的困难和问题，提出相应的对策。方法 采用问卷法对样本地区政府部门及卫生部门的领导、卫生技术人员进行意向调查分析。结果 政府对疾病防制事业投入不足，疾病防制机构普遍存在“重有偿轻无偿、重医轻防”现象，农村卫生服务网络运作不协调，基层农村卫生机构基础设施落后、卫生人才匮乏。结论 政府增加投入，提高农村卫生服务网络整体功能。     

我国农村三级医疗预防保健网的焦点问题、作用机制和发展战略研究结果简介

该简要介绍了“中国农村三级医疗预防保健网的焦点问题、作用机制和发展战略研究”项目的研究结果。农村地区卫生事业发展的焦点问题是“预防保健职能难以切实落实到位或流于形式”，具体表现为“重医轻防、以医养防、重有偿轻无偿、重有收益轻少收益”。问题的根源是政府财政投入不足前提下的允许有偿服务政策，促发因素是缺乏对无偿服务的有效监督机制，建立了“我国疾病防制功能难以切实落实的作用机制模型”。并在此基础上建立了“促使我国疾病防制功能切实落实到位的政策模型”，论证了数种潜在的政策方案。评价了“乡村卫生组织一体化管理”方案实施的社会效果和存在问题。     

定量论证我国疾病防制机构投入机制

运用1986-2010年全国疾病防制机构数据论证发现,2003年开始财政投入没有缺口,但2008年又重新出现明显缺口,尽管2008年之后缺口逐年减少,至2010年仍有数十万元的缺口.从有偿服务支出占疾病防制机构业务支出的比重变化来看,2003年之前全国疾控机构服务重点逐渐往有偿服务上转移,2003年之后重点则往无偿服务上转移.在扣除物价因素后,2002年之前的有偿服务膨胀责任主要归因于财政投入不足,由于财政投入基本没有缺口的原因,2002-2005年责任基本全在机构自身,2008-2009年基本全是财政因素影响,2010年则又以自身因素为主(58.9％～62.8％).     

数据论证疾病防制功能难以落实的作用机制

该文运用调查的实际数据,论证了课题组推论的“社会互动:我国疾病防制功能难以切实落实到位作用机制模型“中各子模的特定内容、各子模之间相互逻辑关系和顺序、疾病防制功能不能落实的根源.模拟论证的结果与逻辑推论、文献归纳分析结果和意向论证结果一致,进一步表明本课题组推论的疾病防制功能难以切实落实到位作用机制模型具科学性、合理性和现实意义.     

意向论证疾病防制功能难以落实的作用机制

该文运用意向调查的数据,论证了课题组推论的“社会互动:我国疾病防制功能难以切实落实到位作用机制模型“中各子模的特定内容、各子模之间相互逻辑关系和顺序、疾病防制功能不能落实的根源.模拟论证的结果与逻辑推论、文献归纳分析结果和数据论证结果一致,进一步表明该课题组推论的疾病防制功能难以切实落实到位作用机制模型具科学性、合理性和现实意义.     

我国切实落实疾病防制功能政策思路的定量模型

通过建立与分析“财政投入模式、有偿服务模式和目前混合模式”的生产函数，定量论证了我国疾病防制机构发展的理想模式；增加对疾病防制预防保健工作的投入适宜性；拓宽各种投入渠道；按服务数量和质量进行拨款。     

从“非典”防控探讨农村传染性疾病应急机制建设

本文通过对在非典防控工作中农村地区存在的问题分析,阐明了农村地区对传染病控制应急反应的薄弱环节,并 针对加强农村传染病的预防控制、建立应急反应机制、科学地应对突发公共卫生事件,提出了建设性的意见,以此 提高农村地区应急机制建设的合理性、完善性、科学性.     

社区疾病预防控制工作指导模式的探究

为更好地落实城乡社区各项公共卫生工作任务,切实加强疾病预防控制中心对基层社区疾控工作的指导能力,浙江省疾病预防控制中心从2007年开始对社区疾病预防控制指导模式进行了探索,认为"城乡社区疾病预防控制责任指导团队模式"在当前疾病预防控制机构编制不足的情况下是可行的,是新形势下城乡社区疾病预防控制工作的重要创新,对于深入贯彻执行卫生部"关口前移、重心下沉"的工作要求,确保各项疾病预防控制工作科学、规范、合理、有序地开展,具有重要意义。     

The illusion of control and the importance of community in health care organizations

The complexity of our health care environment and organizations requires a management style that moves beyond control to empowerment. Even though this complexity minimizes our ability to control events, many organizations are still preoccupied with the illusion of control. This restrains the performance of our health care organizations. Some of the contributing factors supporting this illusion are bureaucracy, scientific methodology, individualism, and our confusion of management with leadership. The concept of "community" is discussed from an organizational perspective. It is suggested that we can improve the performance of our organizations by rediscovering the values of community.     

东中西部地区农村卫生发展比较(三)--卫生筹资比较及农村卫生发展对策

西部地区财政对农村卫生的投入不足,同时,卫生机构对财政的依赖度较高,特别是疾病预防控制机构和妇幼保健机构,医疗机构自身的筹资能力也较差。为加快西部地区农村卫生事业的发展,缩小西部农村地区与东中部地区的差距,体现公共卫生和基本医疗服务的相对均等化,各级政府必须加大对西部地区农村卫生的投入和支持。     

锡山市乡镇卫生院运营现状、问题及改革路径

该文探讨了“苏南模式”乡镇卫生院在农村经济体制变革的情况下面临的新问题。分析了乡镇卫生院的体制、机制缺陷。提出乡镇卫生院改革可选择的路径之一——“公有民营”。但是,在真正代表社区居民意志的社区组织尚未形成的背景下推进这项改革,仍将面临很多困难。     

新型农村合作医疗实施前后定点医疗机构住院费用的比较分析

为研究新型农村合作医疗实施前后定点医疗机构住院费用的变化,采用分层整群随机抽样的方式对禄丰县县级医院和5所乡镇卫生院3年的住院病例进行了统计分析。结果显示:新型农村合作医疗实施后各级医疗机构的住院费用均有不同程度的增长,由此对新型农村合作医疗运行中规范医疗机构行为,控制医疗费用提出建议。     

Community activation and health promotion: identification of key organizations

PURPOSE. The purpose of this study is to identify the kinds of community organizations community leaders consider important for community health promotion efforts. DESIGN. Key informants were identified by reputational sampling of organizations relevant to community health promotion. Key informants were asked to list organizations they considered important for community health promotion. Differences in identified organizations were compared across informants from seven urban, five suburban, seven rural, and three Native American communities, with significance evaluated by chi-square tests. SETTING. This survey was conducted in 22 Western U.S. communities comprising the intervention and control communities of the Community Health Promotion Grants Program of the Henry J. Kaiser Family Foundation. SUBJECTS. Key informants (N = 184) from community organizations, identified using a reputational sampling technique beginning with the health department, were interviewed by telephone. MEASURES. Key informants listed organizations considered important for community health promotion in five areas: adolescent pregnancy, substance abuse, tobacco use, cancer, and cardiovascular disease. RESULTS. Informants frequently identified the health department (mentioned by 78% of informants overall), schools (72%), governmental agencies (55%), hospitals (47%), health clinics (42%), churches (33%), and newspapers (32%) as important. Organizations more prominent in urban and suburban areas than in rural and Native American areas included television stations, health-related private nonprofit organizations, substance abuse treatment centers, and colleges. Private physicians were frequently identified in rural areas (44% of informants).(ABSTRACT TRUNCATED AT 250 WORDS)     

The March to Accountable Care Organizations—How Will Rural Fare?

Purpose: This article describes a strategy for rural providers, communities, and policy makers to support or establish accountable care organizations (ACOs). Methods: ACOs represent a new health care delivery and provider payment system designed to improve clinical quality and control costs. The Patient Protection and Affordable Care Act (ACA) makes contracts with ACOs a permanent option under Medicare. This article explores ACA implications, using the literature to describe successful integrated health care organizations that will likely become the first ACOs. Previous research studying rural managed care organizations found rural success stories that can inform the ACO discussion. Findings: Preconditions for success as ACOs include enrolling a minimum number of patients to manage financial risk and implementing medical care policies and programs to improve quality. Rural managed care organizations succeeded because of care management experience, nonprofit status, and strong local leadership focused on improving the health of the population served. Conclusions: Rural provider participation in ACOs will require collaboration among rural providers and with larger, often urban, health care systems. Rural providers should strengthen their negotiation capacities by developing rural provider networks, understanding large health system motivations, and adopting best practices in clinical management. Rural communities should generate programs that motivate their populations to achieve and maintain optimum health status. Policy makers should develop rural‐relevant ACO‐performance measures and provide necessary technical assistance to rural providers and organizations.