用哲学的眼光解读中国卫生改革三十年的风雨历程

我国卫生改革经历了三十年的风风雨雨，一路走来，公共卫生体系、农村和基层医疗服务体系、居民医疗保障体系逐步健全，同时在科学发展观的指导下，卫生改革的思路越来越清晰，目标越来越明确。以哲学的眼光审视，主要体现在“五个方面”。     

新医改以来公立医院绩效考核政策述评

公立医院改革是深化卫生体制改革的重心,其中公立医院绩效考核政策这方面经历了宏观引导、逐步探索、全面改革三个阶段,每个阶段都有自己的特征,总体呈现出维护公立医院公益性导向、调动医务人员积极性为主的政策思路。在中观层面绩效考核政策已经形成体系,在微观层面绩效考核政策尚需进一步健全。建议增强政策制定的科学性,出台微观层面绩效考核政策及相关配套政策,健全统一协调机制,提高改革的统筹能力。     

为小康社会提供健康保障

正陕西省卫生计生委主任戴征社2016年,我省将继续用医改统领卫生计生事业发展,启动全国综合医改试点工作,深化1市10县改革。"十三五"期间,陕西省卫生计生工作总体思路是"一个行动,四个坚持",即:以实施健康陕西行动为总揽,坚持医疗、医保、医药三医联动,全面深化公立医院综合改革,推动优质资源下沉,健全分级诊疗制度体系,有效缓解群众看病难、看病贵问题;坚持保基本、强基层、建机制,统筹推进公共卫生、医疗服务、医疗保障、药品供应、监     

将改革进行到底

<正>构建县乡一体、以乡带村、三级联动新体系,县域综合医改走出"山西模式"。2018年,山西省卫生健康事业在多个领域取得新发展、新成效。在县域综合医改方面,县乡医疗卫生机构一体化改革在"六统一"管理和"六个机制"创新上取得重大进展,收到了基层服务量、基层服务能力、群众健康素养"三提升",次均费用、自付费用、看病成本"三下降"的良好效果,国家卫生健康     

简讯

日前,从樟树市卫生工作大会上获悉,该市紧扣卫生改革与发展的主题,力争实现“六个”突破:一是从统一认识入手,在抓好初级卫生保健的基础上,全面贯彻全国卫生工作会议精神,力争在树立大卫生观念上有新突破。二是深化改革以来,在不断增强卫生行政部门对卫生工作宏观调控能力的基础上,积极稳妥地改革卫生管理体制,搞好区域卫生规划;改革卫生单位内部运行机制和卫生执法监督体制;三是从抓工作重点入手,在紧密围绕农村卫生、社区医防保健、中医药三大中心工作的基础上,全面推进农村合作医疗制     

山东省卫生应急工作机制和体系建设的现状与思考

<正>近年来,我省卫生应急组织管理体系建设稳步加强,卫生应急预案规范体系不断完善,信息管理和监测预警体系逐步健全,通过各类卫生应急事件处置、预案培训和实战演练,全省卫生应急队伍得到了锻炼,应对各类卫生应急事件的能力和医疗救治水     

黑龙江省卫生经济研究会工作规划(1983年9月——1984年8月)

根据党的十二大、六届人大精神和中国卫生经济研究会工作规划要点,结合我省卫生部门的实际情况,黑龙江省卫生经济研究会在今后一年工作中的基本任务是:在省卫生厅的领导下,认真贯彻党的十二大和六届人大会议精神,逐步建立和健全各地卫生经济研究会,发展会员,扩大队伍,结合我省卫生事业改革的实际,深入开展卫生经济理     

深化卫生改革的思考和建议

从卫生改革的形势分析入手,提出卫生改革的总体思路是注重卫生架构和运行机制设计、摆脱八个误区、实现8个统筹：建议从技术体系、机构体系、人才体系、保障体系、监管体系等五个方面构建卫生体系架构,从资源调配、服务保障、病人分流、监管激励等四个方面完善项卫生工作运行机制。还提出了五大体系、四项机制的实施步骤及调整策略。     

中南六省（区）第三十三次卫生经济学术会议在澄迈成功召开

<正>2019年9月19日,由海南省卫生经济学会主办、上海交大医学院附属新华医院和澄迈县人民医院共同承办、澄迈县人民政府协办的"中南六省(区)第三十三次卫生经济学术会议"在海南省澄迈县召开,本次会议主题为"完善健康体系深化医疗改革"。来自中南六省(区)卫生健康委、卫生经济学会以及综合性医院的领导及专家学者160余人参加了本次会议。澄迈县司迺超县长到会并讲话。     

适应市场经济体制强化依法监督

建国以来，特别是改革开放以来，我国的卫生监督工作有了很大的发展，卫生法律建设不断得到加强，卫生监督体系基本形成，卫生监督队伍已初具规模，为促进卫生事业的发展发挥了重要的作用，但是，随着社会主义市场经济体制的建立，卫生改革的逐步深化，现有的卫生监督已越来越不适应卫生改革与发展的需要，就目前而言，卫生监督工作存在的问题主要表现在以下4个方面。     

The aftermath of health sector reform in the Republic of Georgia: effects on people's health

After the collapse of the Former Soviet Union a health reform process was undertaken in Georgia beginning in 1994. This process was intended to encompass all aspects of the health-care sector and to transform the Soviet-style health system into one that was directed towards quality of care, improved access, efficiency, and a strengthened focus on Primary Health Care (PHC). Health sector reform fundamentally changed the ways health care is financed in Georgia. There has been a transition to program-based financing, and payroll-tax-based social insurance schemes have been introduced. Despite these measures, the performance of the health system is still disappointing. All health programs are severely under-funded, and when the majority of the population is unemployed or self-employed, collection of taxes seems impossible. Overall, Georgian consumers are uninformed about the basic principles of health reforms and their entitlements and therefore do not support them. The analysis introduced in this paper of the current situation in Georgia establishes that the rush to insurance-based medicine was more a rush from the previous system than a well-thought-out policy direction. After 70 years of a Soviet rule, the country had no institutional capacity to provide insurance-based health care. To achieve universal coverage, or at least ensure that the majority of the population has access to basic health services, government intervention is essential. In addition, educating the public on reforms would allow the reform initiators to fundamentally change the nature of the reform process from a top-down centralized process to one that is demand-driven and collaborative.     

Health-care reforms in the Czech Republic

Health-care reform is everywhere. Although different countries are moving at different speeds, using somewhat different means and different routes, they are all trying to arrive at the same place. The place is called "better value for money in health care". Presents details of the health-care reforms taking place in the Czech Republic, identifying and discussing the main strands of Czech reforms: the dissolution of the regional health authorities; the reorientation of district health authorities; the move to a pluralistic semi-competitive insurance-based system; hospitals receiving funding by winning contracts with purchasers; contracts becoming more sophisticated and being based on cost, volume and quality factors; changes in the incentives and rewards for GPs; the drive towards a primary-care-led health-care system; and privatization.     

A systems approach to improving maternal health in the Philippines

Objective

To examine the impact of health-system-wide improvements on maternal health outcomes in the Philippines.

Methods

A retrospective longitudinal controlled study was used to compare a province that fast tracked the implementation of health system reforms with other provinces in the same region that introduced reforms less systematically and intensively between 2006 and 2009.

Findings

The early reform province quickly upgraded facilities in the tertiary and first level referral hospitals; other provinces had just begun reforms by the end of the study period. The early reform province had created 871 women’s health teams by the end of 2009, compared with 391 teams in the only other province that reported such teams. The amount of maternal-health-care benefits paid by the Philippine Health Insurance Corporation in the early reform province grew by approximately 45%; in the other provinces, the next largest increase was 16%. The facility-based delivery rate increased by 44 percentage points in the early reform province, compared with 9–24 percentage points in the other provinces. Between 2006 and 2009, the actual number of maternal deaths in the early reform province fell from 42 to 18, and the maternal mortality ratio from 254 to 114. Smaller declines in maternal deaths over this period were seen in Camarines Norte (from 12 to 11) and Camarines Sur (from 26­ to 23). The remaining three provinces reported increases in maternal deaths.

Conclusion

Making health-system-wide reforms to improve maternal health has positive synergistic effects.     

Here we go again--lessons on health reform

The 2008 election will focus renewed attention on fundamental health care reform. Lessons from past politically driven reform efforts show that although fundamental reforms may make for good politics, a systemic shift in how health care is financed and delivered is unlikely to occur. Calls for fundamental reform over the past twenty-five years have prompted incremental changes that have had a major impact on the U.S. health care system. Many of these changes were driven from outside the political system. The forecast based on past experience is not radical change; it is more of the same.     

Transformation of ministries of health in the era of health reform: the case of Colombia

Ministries of health are being called upon to lead major health reforms; at the same time they must reform themselves to become more modern institutions and assume new and different functions and roles in the more dynamic reformed system. The literature on public administration and on health reform has recommended many processes of institutional reform and development, building on private sector management techniques, popularized by 'reinventing government' and 'total quality management'. More recently, thoughtful insights have emphasized improving public management through a focus on creating 'public value'; on political, as well as administrative, leadership; improving institutional performance through strengthening the 'task networks' of organizations needed to achieve strategic objectives; and creating a learning culture within the organization. This article applies these recent approaches to the specific needs of ministries of health in order to improve their capacity to lead major health reforms. This combined approach is then used to analyze and make recommendations to the Ministry of Health in Colombia where the authors were providing technical support for a major new health reform.     

Mental health system reform: a multi country comparison

In recent years many countries have embarked on various types of health and mental health reform. These reforms have in large part been driven by governments' concerns for cost containment which has, in turn, been driven by an increasing process of global marketization and the need to control national deficits. A critical issue in these reforms is the increased emphasis on the use of "market mechanisms" in the delivery of health and mental health services. This paper uses a policy analysis framework to compare recent developments in the mental health sector in Canada, the United States, Britain and Australia. The common framework to be used for this will focus on: the defining characteristics of the society; legislative mandate; sectorial location (within or separate from health sector); funding streams; organising values of the system; locus of service delivery; service technologies; the role of social work; interprofessional dynamics; the role of consumers; and evaluation of outcomes at multiple levels. This analysis provides an opportunity to explore similarities and differences in mental system reform and in particular identify the challenges for social work in the field of mental health in the 21st century.     

Mexican health insurance: uncertain universal coverage

The Mexican health system is comprised of the Department of Health, state labor social security and the private sector. It is undergoing a reform process initiated in 1995 to achieve universal coverage and separate the regulation, financing and service functions; a reform that after fifteen years is incomplete and problematic. The scope of this paper is to assess the problems that underlie the successive reforms. Special emphasis is given to the last reform stage with the introduction of the "Insurance of the People" aimed at the population without labor social security. In the analysis, health reform is seen as part of the Reform of the State in the context of neoliberal reorganization of society. Unlike other Latin American countries, this process did not include a new Constitution. The study is based on official documents and a systematic review of the process of the implementation of the System of Social Health Protection and its impact on coverage and access to health services. The analysis concludes that it is unlikely that universal population coverage will be accomplished much less universal access to services. However, reforms are leading to the commodification of the health system even in the context of a weak private sector.     

Health insurance reform in Vietnam: a review of recent developments and future challenges

Vietnam is undertaking health financing reform with a view to achieve universal coverage of health insurance within the coming years. To date, around half of the population is covered with some type of health insurance or prepayment. This review applies a conceptual framework of health financing to provide a coherent assessment of the reforms to date with respect to a set of key policy objectives of health financing, including financial sustainability, efficiency in service provision, and equity in health financing. Based on the assessment, the review discusses the main implications of the reforms focusing on achievements and remaining challenges, the nature of the Vietnamese reforms in an international perspective, and the role of the government. The main lessons from the Vietnamese experiences, from which other reforming countries may draw, are the need for sustained resource mobilization, comprehensive reform involving all functions of the health financing system, and to adopt a long-term view of health insurance reform. Future analysis should include continued evaluation of the reforms in terms of impacts on key outcomes and the political dimensions of health reform.