美国的卫生保健体制(Ⅱ)

2卫生保健服务的提供者 一般说来,为病人或顾客提供医疗卫生服务的人员和机构是卫生保健服务的提供者.提供服务的人员包括医生、护士、其他职业人员、行政管理人员和社会工作者.提供卫生保健服务的机构包括医院、门诊部、健康维护组织、公共卫生机构、护理院及其他卫生机构.     

职业卫生服务与初级卫生保健整合服务模式

概述职业人群面临的健康风险及其影响、初级卫生保健和职业卫生服务的相关内容与发展,阐述两者整合的必要性,并与对国内外两者整合服务模型进行综述,最后针对我国大陆在职业卫生服务与初级卫生保健方面存在的问题,提出相应的建议.     

论我国卫生保健服务的公平性

卫生保健服务公平性是指无论社会成员的社会地位、收入等因素如何,都应该以需求为导向获得卫生保健服务。通过卫生保健服务公平性评价体系,分析目前在我国卫生保健服务的公平性方面存在着卫生保障覆盖面小、卫生资源配置不平衡及卫生服务费用分担不合理等问题。要改变这一状况,就应该从增加卫生资源的投入、优化卫生资源配置结构、健全和完善医疗保障制度方面着手,推进卫生保健服务的公平,使每一个社会成员都能得到基本的、公平的卫生保健服务,最终实现人人享有卫生保健的目标。     

部分国家卫生保健体制及卫生费用投入研究

卫生保健体制是指一个国家卫生政策框架的结构属性。从世界范围看,卫生保健体制可分为:福利性、风险性、福利风险性三种。福利性卫生保健体制主要是由国家计划调控,提供以福利为主的卫生保健服务。风险性卫生保健体制主要靠市场调节和国家补贴进行调控,根据疾病的风险和费用的风险提供卫生服务,国家只提供部     

中澳社区卫生服务的比较研究

中国曾经是发展中国家初级卫生保健的榜样.然而近年来,卫生资源配置越来越集中于大城市、大医院和高精尖技术领域,服务的可及性和公平性下滑.为了有效解决这些问题,全国各地自1997年以来广泛开展了社区卫生服务.但是,这些实践与政策目标之间还存在相当大的距离.本文通过对比中澳两国社区卫生服务模式,对中国的社区卫生服务提出了一些建议.认为当务之急应该是整合现有的社区资源,成立初级卫生保健同盟,避免卫生资源的重复配置和浪费,增强消费者对社区卫生服务的信心.     

医院积极参与初级卫生保健

从当代医院发展的必然趋势，医院服务模式和工作重心转移，以及医院必须承担的历史责任和现实需要，论述了医院扩展功能、参与初级卫生保健的必要性。提出了医院加强第一级接触的医疗服务、搞好临床三级预防、开展社区综合性卫生保健服务、指导帮助农村和基层实施初级卫生保健、大力开展健康教育等５项主要任务。并就扩展医院功能、支持和参与初级卫生保健应该解决的问题，提出了看法和意见。     

高校医疗机构实施全科医学卫生保健模式初探

目的探索高校医疗机构如何实施全科医学卫生保健的模式。方法采用文献研究法,同时结合笔者多年从事全科医学工作的实践经验,分析了高校医疗机构实施全科医学卫生保健模式的重要性和必要性。结果随着医疗制度改革的不断完善,高校医疗机构发展全科医学卫生保健模式,实施全科医疗服务势在必行。结论高校医疗机构应建立以人为中心,以维护和促进健康为目标,融医疗、预防、保健、康复、健康教育和计划生育技术服务为一体的全科医学卫生保健模式。     

铁路保健站如何开展初级卫生保健工作

2000年人人享有卫生保健是世界卫生组织提出的全球战略目标,“初级卫生保健是实现这一目标的关键”。初级卫生保健是我国卫生体系的重要组成部分,是使卫生保健最大限度地深入到人们工作和生活的场所的一种保健服务。因此,初级卫生保健是国家卫生体系的基本和核心,也是社会经济发展的重要内容。 笔者多年从事铁路基层保健工作,深切体会到,做好企业的初级卫生保健工作,必须转变观念,争取领导,改进服务,     

试论海南农垦农场卫生保健服务模式对初级卫生保健的适应性和优越性

海南农垦是一个全民所有制的大型企业,主要经营橡胶、茶叶等热带作物。拥有国营农场(所)96个,内设有分场365个,生产队3736个,总人口约一百万。这些农场遍布海南省各市县,而且大多数地处山区。农场卫生保健服务模式的主要特点及其对初级卫生保健的适应性在于: 1 组织机构健全,卫生保健服务形成网络,复盖面广     

企业职工卫生保健状况调查

在改革开放的新形势下,对企业职工进行卫生保健工作、为职工提供医疗保险及社区医疗服务,是我们今后开展城市初级卫生保健工作的一项重要内容。本调查通过了解企业职工的卫生状况和医疗保健需求,为今后开展该职业人群的卫生保健工作提供参考。1 对象和方法     

EDITORIAL

No abstract available for this article.     

Ranking of priorities in employees' reward and recognition schemes: from the perspective of UAE health care employees

A reward and recognition (RR) system is a tool widely applied by organizations to motivate their employees. Outstanding employees expect their effort to be acknowledged by the organization. However, the variety of rewards and recognitions systems used by organizations may be perceived differently by different employees. The diverse workforce structure in the United Arab Emirates (UAE) poses various challenges for organization managers. Managers need to implement the shrewd RR system which best fits their diverse workforce. This research studied how medical sector employees in the private and public health sector view the RR systems in the UAE. Two lists, comprising 26 major approaches to RR, were prepared and its items prioritized by taking inputs from 250 employees working in more than 30 varied public and private health care organizations in the UAE. The findings of the research are expected to provide guidelines for developing appropriate RR systems for organizations in general, and UAE health care organizations in particular.     

Progress of Ontario's Family Health Team model: a patient-centered medical home

Ontario's Family Health Team (FHT) model, implemented in 2005, may be North America's largest example of a patient-centered medical home. The model, based on multidisciplinary teams and an innovative incentive-based funding system, has been developed primarily from fee-for-service primary care practices. Nearly 2 million Ontarians are served by 170 FHTs. Preliminary observations suggest high satisfaction among patients, higher income and more gratification for family physicians, and trends for more medical students to select careers in family medicine. Popular demand is resulting in expansion to 200 FHTs. We describe the development, implementation, reimbursement plan, and current status of this multidisciplinary model, relating it to the principles of the patient-centered medical home. We also identify its potential to provide an understanding of many aspects of primary care.     

Improvements in Health Status after Massachusetts Health Care Reform

Context

Massachusetts enacted health care reform in 2006 to expand insurance coverage and improve access to health care. The objective of our study was to compare trends in health status and the use of ambulatory health services before and after the implementation of health reform in Massachusetts relative to that in other New England states.

Methods

We used a quasi-experimental design with data from the Behavioral Risk Factor Surveillance System from 2001 to 2011 to compare trends associated with health reform in Massachusetts relative to that in other New England states. We compared self-reported health and the use of preventive services using multivariate logistic regression with difference-in-differences analysis to account for temporal trends. We estimated predicted probabilities and changes in these probabilities to gauge the differential effects between Massachusetts and other New England states. Finally, we conducted subgroup analysis to assess the differential changes by income and race/ethnicity.

Findings

The sample included 345,211 adults aged eighteen to sixty-four. In comparing the periods before and after health care reform relative to those in other New England states, we found that Massachusetts residents reported greater improvements in general health (1.7%), physical health (1.3%), and mental health (1.5%). Massachusetts residents also reported significant relative increases in rates of Pap screening (2.3%), colonoscopy (5.5%), and cholesterol testing (1.4%). Adults in Massachusetts households that earned up to 300% of the federal poverty level gained more in health status than did those above that level, with differential changes ranging from 0.2% to 1.3%. Relative gains in health status were comparable among white, black, and Hispanic residents in Massachusetts.

Conclusions

Health care reform in Massachusetts was associated with improved health status and the greater use of some preventive services relative to those in other New England states, particularly among low-income households. These findings may stem from expanded insurance coverage as well as innovations in health care delivery that accelerated after health reform.     

The demand for private health care in the UK

Policy change has eroded the entitlement of UK residents to free state-provided health care, with a resulting rise in the use of the private sector. This paper examines the choice between public and private health care. It models the use of private health care as a function of its costs and benefits relative to state care and no care. The results indicate a difference between users of private care and other care, and the importance of past use as a predictor of current use. But they also show considerable movement between the public and private sectors, indicating a complex relationship in public and private sector use.     

挪威卫生服务体系概况及对我国的启示

本文通过对挪威卫生服务体系的发展脉络进行追溯,了解到挪威政府对初级卫生保健体系和专科卫生服务体系一直采取不同的管理模式,并随着人口结构、卫生服务需求的变化将初级卫生保健逐步交由自治市政府管理,而专科卫生服务则采取了市场化较强的半政府、半市场的组织管理模式,并由中央政府进行统筹。这样的管理结构从目前来看较好的解决了初级卫生服务供给不足和专科卫生服务效率低下的问题。     

From Triple to Quadruple Aim: Care of the Patient Requires Care of the Provider

The Triple Aim—enhancing patient experience, improving population health, and reducing costs—is widely accepted as a compass to optimize health system performance. Yet physicians and other members of the health care workforce report widespread burnout and dissatisfaction. Burnout is associated with lower patient satisfaction, reduced health outcomes, and it may increase costs. Burnout thus imperils the Triple Aim. This article recommends that the Triple Aim be expanded to a Quadruple Aim, adding the goal of improving the work life of health care providers, including clinicians and staff.     

Organizational Leadership For Building Effective Health Care Teams

The movement toward accountable care organizations and patient-centered medical homes will increase with implementation of the Affordable Care Act (ACA). The ACA will therefore give further impetus to the growing importance of teams in health care. Teams typically involve 2 or more people embedded in a larger social system who differentiate their roles, share common goals, interact with each other, and perform tasks affecting others. Multiple team types fit within this definition, and they all need support from leadership to succeed. Teams have been invoked as a necessary tool to address the needs of patients with multiple chronic conditions and to address medical workforce shortages. Invoking teams, however, is much easier than making them function effectively, so we need to consider the implications of the growing emphasis on teams. Although the ACA will spur team development, organizational leadership must use what we know now to train, support, and incentivize team function. Meanwhile, we must also advance research regarding teams in health care to give those leaders more evidence to guide their work.     

The labour market costs of community care

This paper reports an empirical investigation into the influence of informal care responsibilities on the labour supply of women. The objective is to examine the argument that the UK policy of caring for the chronic sick 'in the community' involves a nontrivial opportunity cost in the form of the forgone labour supply of the informal carers upon which it relies. We find that informal carers who care for less than 20 h per week are, in fact, more likely to participate in the labour market, but tend to work for fewer hours per week than otherwise similar noncarers. Informal carers who care for 20 h or more a week are less likely to participate, but only slightly. However, when they do undertake formal employment, they tend to earn less per hour and work for fewer hours per week.