英国国家卫生服务体系近年改革对我国的启示

对21世纪以来英国国家卫生服务体系三次重大改革进行简述,重点着眼于这三次改革的依据、原因和措施,分析了其改革的具体特点,并对改革进行了评价,以期能对我国医疗制度改革提供一个借鉴。     

我国公共卫生筹资改革措施评价

我国公共卫生筹资改革有两个明显特点：一是政府经费补助相对减少，二是对公共卫生服务实行有偿服务，改变了公共卫生机构的筹资结构。在1980年实行筹资改革以前，公共卫生机构的一切支出全部由政府经费补偿；在实行改革之后的90年代中期，政府经费占机构总收入的比例下降到30％－50％，仅能补偿人员工资，有偿收入所占比例相应地增加到50％－70％，以市场为导向的公共卫生筹资虽能提高机构的经济活力与生产效率，但同时也暴露出一些问题。经济激励机制导致了不必要卫生服务的过度提供与必要卫生服务的提供不足。有偿服务减少了人们对具有正外部效应的预防保健服务的需求和利用，政府经费不足导致了公共产品的供给不足。以往的实践证明：政府在公共卫生筹资中的作用减弱可导致社会资源利用的低效率；实行有偿服务会抑制人群对这些服务的需求，增加疾病发生的危险性；以市场为导向的公共卫生筹资改革不能作为一项政策选择，一旦采用这类政策，就会造成许多不良后果。     

Trust,risk and health care reform

Across the developed world, governments face severe challenges in health care reform as demand rises and resource constraints grow more stringent. In the UK, the current government is devoting considerable resources to welfare state reform and (arguably) achieving real improvements in services such as the NHS and education. Despite this, the reforms remain highly controversial and there is considerable concern about lack of trust in the new welfare policies. A decline in trust may undermine the public acceptability of the reforms and threaten the ability of government to gain electoral support for them. Recent work in sociology, political science and psychology indicates that rational deliberative and non-rational valued-based or affective factors contribute to trust in institutions. At the same time, theoretical arguments suggest an increasing need for public trust. Trust facilitates the co-ordination of complex enterprises under conditions of uncertainty, especially valuable at a time when rising demand and intensifying pressures for spending constraint provide a continuing impetus for reform. One possibility is that policies designed within a rational actor framework may erode the non-rational aspects of trust, so that the service improves but trust in it declines, with consequences for the political sustainability of reformed health care systems. Risk research in health care has a good opportunity to consider issues of institutional trust and to build inter-disciplinary links in doing so.     

我国医改政策公众参与机制研究

目的 比较分析我国当前与既往医改政策形成过程中公众参与的程度变化特征.方法 运用政策分析法对近年来不同阶段中的医改政策形成过程进行比较.结果 医改的传统政策形成过程主要在政府部门内部纵向循环产生;现阶段医改政策制定形成过程不仅通过了多部委联合工作和独立的研究机构参与平行研究的横向循环所产生,还多次广泛征求了社会各界的建议.结论 当前医改扩大了公共政策形成的参与主体构成,表现出公共政策形成过程中公众参与程度的提高,反映了公共管理变革的趋势.建议应进一步建立稳定的公众参与机制以适应社会发展的要求.     

公立医疗机构补偿机制改革的思考

该文以当前卫生改革的热点为题,通过深入分析公立医院补偿机制的4方面问题,提出了相应的改革思路。     

深圳公共卫生事业在医改中全面健康发展

全面加强公共卫生服务体系建设是医改的重要任务和目标.作者介绍了深圳市公共卫生事业在医改中的发展情况.深圳围绕目标要求,不断探索创新,取得了一定的成效:公共卫生服务机构公益性不断体现,国家、深圳市的重大和基本公共卫生服务逐步落实,公共卫生服务能力全面提升,疾病发病率和死亡率显著降低.同时,结合深圳社会经济发展状况和市民健康需求,深圳市的公共卫生工作仍有一些问题急需解决,如公共卫生服务网络体制、公共卫生机构激励机制有待健全和完善,公共卫生服务能力需进一步提升.     

我国卫生领域信任缺失问题研究

我国卫生领域信任缺失是个值得关注的问题。在分析我国卫生领域信任缺失分别在人际领域、组织机构领域、卫生系统领域表现的基础上,从制度层面、社会层面和个体层面探讨了卫生领域信任缺失的因素,由此提出完善我国卫生制度、加强卫生职能部门的政策能力、治理卫生行业腐败、加强医务人员道德教育的建议,从制度、社会环境和个人道德修养3个方面共同构建卫生领域的社会信任。     

Professional autonomy and managed care in Dutch health centres: stakeholders' perceptions of a strategic option

The on-going reforms of the Dutch health care systems call for the introduction of managed care elements. Health centres in the Netherlands already bear some resemblance to health maintenance organizations in the USA. However, managed care challenges provider autonomy, and the strategic development of managed care plans may be hampered by providers' perceptions. We draw a distinction between managed care within an insurance arrangement and managed care as a package of methods. Both options are evaluated as suitable for Dutch health centres, though with differences in terms of strategic logic and cultural fit. Lastly, some general conditions are formulated that should be considered before care management processes can be implemented. These include: specify clear objectives for introduction of managed care; strengthen corporate culture; develop internal motivation for change; develop a practice criterion with health centre professionals; reduce workloads in order to provide development time; and, promote better cooperation between general practitioners and specialists.     

我国公共卫生教育教学方法改革浅析

[目的]探讨目前我国公共卫生教育中教学方法的现状及弊端，归纳和分析我国公共卫生教学方法改革的趋势，为提出我国公共卫生教学方法改革基本思路奠定基础。[方法]采用查阅文献和资料、网上查询等方式对目前我公共卫生教育所采用的教学方式及改革趋势进行调查、整理与归纳。[结果]我国目前公共卫生教育大多采用传统教学方式，改革面临困境和问题，部分院校进行了初步的改革尝试。[结论]我国公共卫生教育的教学方法落后于现代公共卫生教育的需要，成为阻碍制约教学改革的瓶颈，部分院校所引进的国外公共卫生教育的教学方法与改革值得学习与借鉴。     

我国医疗卫生改革进展与展望

系统回顾了我国医疗卫生改革的过程，目的在于识别改革过程中出现的问题，并对新一轮改革做一些展望：根据一些重要事件和政策发布时间，将我国医疗卫生改革划分为五个阶段，分析发现中国医疗卫生改革总体上是同社会经济领域的其他改革是同步的。     

Trust in health care encounters and systems: a case study of British pensioners living in Spain

Research on trust in health care faces two enduring challenges. Firstly, there are conceptual ambiguities in distinguishing trust from related concepts, such as confidence or dependence. Second, the tacit understandings which underpin the ‘faith’ element of trust are difficult to explicate. A case study of British pensioners who have moved to Spain provides an opportunity to explore trust in a setting where they often have a choice of where to access health care (UK or Spain), and are therefore not in a state of dependence, and in which the ‘differences’ of a new field generates reflection on their tacit expectations of providers and systems. In accounting for decisions to use (or not to use) Spanish health care, British pensioners cited experiential knowledge of symbolic indicators of trustworthy institutions (they were hygienic, modern, efficient), which contributed to background confidence in the system, and interpersonal qualities of practitioners (respect for older people, embodied empathy and reciprocity) which evoked familiar relations, within which faith is implicit. In contrast, with limited recent access to the British system, their background confidence had been compromised by reports of poor performance, with few opportunities to rebuild the interrelational bases of trust.     

乡镇卫生院产权改革的探讨

乡镇卫生院产权改革符合中央精神和国情。到２０００年３月,邗江县的２４所乡镇卫生院全部实行改制,进入了正常运行。在以上论述的基础上,作者首先指出,不同产权医疗机构存在是必要的。其次阐述了对改制后的医疗机构统一由卫生行政部门实施卫生法律监督。第三论述了改制后的乡镇卫生院出现的可喜变化。如改变了服务模式、改善了服务态度、苦练内功等。第四明确提出了卫生行政部门对改制医院要一视同仁、不能歧视,要为改制医院提     

Enumerating the preventive youth health care workforce: Size,composition and regional variation in the Netherlands

The progress in workforce planning in preventive youth health care (YHC) is hampered by a lack of data on the current workforce. This study aimed to enumerate the Dutch YHC workforce. To understand regional variations in workforce capacity we compared these with the workforce capacity and the number of children and indicators of YHC need per region.A national survey was conducted using online questionnaires based on WHO essential public health operations among all YHC workers. Respondents (n = 3220) were recruited through organisations involved in YHC (participation: 88%).The YHC workforce is multi-disciplinary, 62% had >10 years working experience within YHC and only small regional variations in composition existed. The number of children per YHC professional varied between regions (range 688–1007). All essential public health operations were provided and could be clustered in an operational or policy profile. The operational profile prevailed in all regions. Regional differences in the number of children per YHC professional were unrelated to the indicators of YHC need.The essential public health operations provided by the YHC workforce and the regional variations in children per YHC professional were not in line with indicators of YHC needs, indicating room for improvement of YHC workforce planning. The methodology applied in this study is probably relevant for use in other countries.     

芜湖市医药卫生体制改革的实践与探索

自2007年,芜湖市探索以创新医药卫生工作体制机制为核心,以公立医院改革和基层医药卫生体制综合改革为两翼,以全面加强公共卫生服务体系建设、完善基本医疗服务体系、加快建设医疗保障体系、健全药品供应保障体系为动力的“一核两翼四轮驱动”的改革模式,总结芜湖市医改的主要做法及取得的实效.     

农村公共卫生服务体系绩效评价指标在农村卫生改革中的实践

目的:评价中国农村卫生发展项目(简称"卫十一项目")实施期间,项目地区公共卫生服务体系的绩效。方法:采用项目开发的农村公共卫生服务绩效评价指标体系,连续收集40个项目县2008—2013年的投入、产出指标,进行综合分析与评价。结果:项目地区2008—2013年间公共卫生的投入和产出均逐年提高,分别由项目初期的22.73分和39.05分增加到32.62分和57.60分,增幅达43.15%和47.50%,部分项目省份投入增幅较产出明显。项目地区投入产出比从1.72增加到1.77,年间略有波动。结论:采用公共卫生服务体系绩效考核指标监测项目实施进程,有利于及时发现农村公共卫生服务体系建设中存在的薄弱环节,从而针对性地采取有效措施促进体系的完善。在加大公共卫生投入的时候,如何高效利用资源,提高服务效果依然是亟需解决的问题。     

深圳市医药卫生体制改革三年回顾及展望

介绍了深圳市新医改建设中推进四大体系、八项体制机制的进展情况;阐述了深圳市推进公立医院改革试点及重大体制机制改革工作;回顾推进医药卫生体制改革的主要成效,并对进一步深化医药卫生体制改革做出展望.     

公立医院开展患者满意度测评现状

随着顾客满意度理论的深入发展,患者满意度作为衡量现代医院质量管理工作的"金标准",逐步引入医疗卫生系统。本文通过对国内外患者满意度测评的基本现状和进展进行分析描述,找出国内在患者满意度研究中存在的一些问题,并提出相关的改进建议,为国内关于患者满意度测评的研究提供参考,从而使患者满意度测评更好地发挥作用。     

Measuring Trust in Primary Care

Policy Points

• Trust in primary care clinicians is essential for effective patient care and is associated with better health outcomes, but it is rarely assessed, and existing measures have not been thoroughly evaluated.
• This scoping review reveals that research assessing patients’ trust in primary care clinicians largely stopped more than a decade ago but offers candidate measures for future testing, implementation, and policy applications.