中国社会办医的现状分析

通过系统分析中国社会办医的现状,为进一步促进社会办医提出政策建议。根据国内外文献,社会办医疗机构和公立医疗机构在医疗费用和服务质量方面并没有显著差异,并且由于社会办医促进市场开放与公平竞争,公立医院和整个医疗卫生服务市场的绩效也因此有所提高（正向溢出效应）。尽管如此,由于中国长期计划经济自上而下的资源配置与行政干预,社会办医长期未能得到健康发展,主要政策障碍包括准入方面存在隐形限制、经营方面缺乏税收鼓励、用人方面缺少优质医师资源。因此,建议调整区域卫生规划的功能从“封顸”向“兜底”过渡,尽快制定有利于社会办医的土地政策和人才政策,进一步完善相关配套措施,促进社会办医在中国的健康发展。     

新时期中古卫生改革比较研究及启示

古巴和中国在社会制度、政治体制以及在卫生改革历程方面有很多共同点,但也存在一些差异。本研究比较了新的历史时期,古巴和中国的卫生改革情况,借鉴古巴卫生改革的基本原则和思路,为中国卫生体制改革提出了政府应重新理解和定位社区卫生服务,确立医疗卫生主导地位,调动医务人员积极性,坚持医学教育规划与卫生资源市场调研以及要将市场和政府监管结合起来等建议。     

理性评估中国医改三年成效

新一轮医改三年来进展顺利,在促进基本公共卫生服务逐步均等化、加快推进基本医疗保障制度建设、初步建立国家基本药物制度、健全基层医疗卫生服务体系、推进公立医院改革试点等方面取得明显成效,基层基本医疗卫生制度模式初现雏形。理性评价医改三年的成效,客观分析其中存在的问题,直接影响到进一步推进和完善医改。本文根据评估标准,对三年医改成效、进展和制度建设进行评估,并就下一步医改面临的挑战提出政策建议。     

关于对中国西部农村卫生政策缺陷的探讨

文章根据中国西部卫生状况,结合新医改思想,从新型农村合作医疗、基本医疗卫生服务、农村卫生基本建设、农村卫生人力资源、公立医院改革5个方面剖析当前存在的卫生政策缺陷.建议,西部卫生政策的实施,更要结合西部卫生实际情况,真正使政策落到实处,达到政策目的.     

新中国70年初级卫生保健回顾与展望

新中国成立70年以来,我国一直在丰富着初级卫生保健（PHC）的内涵和实践,用较小的投入取得了较好的健康绩效。本文将我国70年来初级卫生保健发展历程分四个阶段,总结了在基层卫生服务体系、医保覆盖、基层卫生人力、基本公共卫生服务项目、妇幼保健、健康扶贫等方面取得的成效,并提炼出中国初级卫生保健的经验,分析了面临的问题与挑战,提出了未来的发展建议。     

美国卫生体系面临的挑战及对中国的启示

本文系统分析了美国卫生体系面临的挑战及其原因。文章认为美国卫生体系目前存在诸多挑战:卫生支出大幅增加、医疗服务利用不足与过度并存、健康水平低于大多数发达国家、基层医疗机构全科医生数量明显不足等。而国家立法的失误、卫生管理系统不够完善等是造成美国卫生体系面临众多挑战的主要原因。吸取上述美国的历史教训,结合中国国情,提出以下启示:应保障人人享有卫生保健的基本权利;重视和发挥政府以及基层医疗机构的作用;加强全科医生队伍建设;改革支付方式,控制医疗费用的增长;加强立法,合理处理医疗事故和纠纷。     

Quality Improvement in Healthcare Delivery Utilizing the Patient-Centered Medical Home Model

Despite the fact that the United States dedicates so much of its resources to healthcare, the current healthcare delivery system still faces significant quality challenges. The lack of effective communication and coordination of care services across the continuum of care poses disadvantages for those requiring long-term management of their chronic conditions. This is why the new transformation in healthcare known as the patient-centered medical home (PCMH) can help restore confidence in our population that the healthcare services they receive is of the utmost quality and will effectively enhance their quality of life. Healthcare using the PCMH model is delivered with the patient at the center of the transformation and by reinvigorating primary care. The PCMH model strives to deliver effective quality care while attempting to reduce costs. In order to relieve some of our healthcare system distresses, organizations can modify their delivery of care to be patient centered. Enhanced coordination of services, better provider access, self-management, and a team-based approach to care represent some of the key principles of the PCMH model. Patients that can most benefit are those that require long-term management of their conditions such as chronic disease and behavioral health patient populations. The PCMH is a feasible option for delivery reform as pilot studies have documented successful outcomes. Controversy about the lack of a medical neighborhood has created concern about the overall sustainability of the medical home. The medical home can stand independently and continuously provide enhanced care services as a movement toward higher quality care while organizations and government policy assess what types of incentives to put into place for the full collaboration and coordination of care in the healthcare system.     

中国卫生改革与发展蓝图的构想

解决当前“看病难、看病贵”问题涉及到卫生服务的可及性、公平性和成本问题,但这并不是卫生改革和发展要达到的最终目的,“看病难”和“看病贵”体现了中国卫生系统的“制度性疾病”。提出了中国卫生改革与发展蓝图框架结构,即:实现1个目标(普及基本卫生服务)、健全3个制度(基本医疗保险制度、基本卫生服务制度和基本药物制度)及实施6个政策策略。在未来的15年内,中国将在“以人为本,科学发展观”的思想指引下,建设一个和谐的、社会主义的小康社会。构建和谐社会,普及基本卫生服务是全国人民的愿景。为强化政府对基本卫生服务的保障责任,促进卫生服务的公平性,设想能否将“普及基本卫生服务”与“普及九年义务教育”共同构成中国最主要的2个社会政策。实现“普及基本卫生服务”是一个长期的过程,体现卫生事业发展要与经济发展水平相适应,需要动员全社会共同参与。     

浅析美国医改的效益及借鉴意义

美国于当地时间2010年3月21日通过了酝酿已久的医改法案,本法案的通过成为美国各界普遍关注的焦点,也引起了世界各国的关注。为了使人们能够从卫生政策角度了解这项法案,本文从社会效益和经济效益两方面对医改法案作了介绍,包括:保险支付、保险公司责任、药品补贴、人力资源配置、公共卫生、服务质量、税收、保险欺诈和成本控制。分析了美国医改对中国医改的借鉴意义,提出了适当加大政府对大病、慢病和弱势群体卫生投资的重要性。同时卫生服务系统的规划要考虑成本控制措施,如加强预防和疾病控制、减少浪费和诱导需求。在卫生改革过程中引入质量管理手段和医疗信息化管理是医疗卫生发展的趋势,也是中国卫生事业管理发展的必由之路。     

Skill mix and patient outcomes: A multi-country analysis of heart disease and breast cancer patients

Policymakers are becoming aware that increasing the size of the healthcare workforce is no longer the most viable way to address the increasing demand for healthcare. Consequently, a focus of recent healthcare workforce reform has been extending existing roles and creating new roles for health professionals. However, little is known of the influence on outcomes from this variation in labour inputs within hospital production functions. Using a unique combination of primary and administrative data, this paper provides evidence of associations between the composition of care delivery teams and patient outcomes. The primary data enabled the construction of a task component-based measure of skill mix. This novel measure of skill mix has the advantage of capturing how workforce planning can restructure the relative input of nurses or physicians into task components while keeping the overall level of staff fixed. The analysis focuses on specific care pathways and individual hospitals, thus controlling for an under-investigated source of heterogeneity. Additionally, stratifying by country (England, Scotland, and Norway) enabled analysis of skill mix within different health systems. We provide evidence that variations in labour inputs within the breast cancer and heart disease care pathways are associated with both positive and adverse outcomes. The results illustrate the scope for substitution of task components within care pathways as a potential method of healthcare reform.     

User fees and health service utilization in Vietnam: how to protect the poor?

OBJECTIVES: Vietnam started its health reform process two decades ago, initiated by economic reform in 1986. Economic reform has rapidly changed the socio-economic environment with the transition from a centrally planned economy to a market-oriented economy. Health reform in Vietnam has been associated with the introduction of user fees, the legalization of private medical practices, and the commercialization of the pharmaceutical industry. This paper presents the user fees and health service utilization in Vietnam during a critical period of economic transition in the 1990s. STUDY DESIGN: The study is based on two national household surveys: the Vietnam Living Standard Survey 1992-1993 and 1997-1998. METHODS: The concentration index and related concentration curve were used to measure differences in health service utilization as indicators of health outcomes of income quintiles, ranking from the poorest to the richest. RESULTS: User fees contribute to health resources and have helped to relieve the financial burden on the Government. However, comparisons of concentration indices for hospital stays and community health centre visits show that user fees can drive people deeper into poverty, widen the gap between the rich and the poor, and increase inequality in health outcomes. CONCLUSIONS: An effective social protection and targeting system is proposed to protect the poor from the impact of user fees, to increase equity and improve the quality of healthcare services. This cannot be done without taking measures to improve the quality of care and promote ethical standards in health care, including the elimination of unofficial payments.     

地方政府分级诊疗政策创新扩散研究 ——基于全国地级市数据的事件史分析

地方政府卫生政策改革创新对于深化我国医药卫生体制改革具有重要意义.本研究以我国分级诊疗政策为例,收集并构建了全国170个地级城市2014—2018年五年时间内的数据库,采用事件史方法分析了地方分级诊疗政策出台的影响因素.研究发现,地方政府卫生政策改革创新呈现自下而上政策推广和横向竞先模式;卫生部门、医保部门和大型公立医...     

对深化医药卫生体制改革的再认识——学习《中共中央关于全面深化改革若干重大问题的决定》体会

以党的十八届三中全会通过的《中共中央关于全面深化改革若干重大问题的决定》为指导,进一步分析了我国医药卫生体制改革进展和瓶颈,对医疗卫生服务的产品属性、市场和市场在医疗卫生服务领域的作用、拓展和深化医药卫生体制和公立医院改革走向进行了剖析。文蕈认为：深化医药卫生体制改革应该从系统论观点出发,针对医疗卫生服务的复杂性．在界定不同医疗卫生服务产品属性的基础上,明确政府和市场的责任：统筹规划医疗卫生资源,进一步完善医药卫生的管理体制和运行机制,特别是公立医院的管理体制和运行机制,扭转公立医院的趋利倾向,向全体居民提供公平、可及、支付得起的公共卫生和基本医疗卫生服务：鼓励社会办医,满足广大人民群众不断增长的、多层次的医疗卫生服务需求。     

Introducing the health coach at a primary care practice: impact on quality and cost (Part 1)

The cost of healthcare in U.S. is a poor value proposition. One of the primary goals of the healthcare reform act is to reduce cost while improving healthcare quality. We believe that adding a health coach will help in achieving this goal. The health coach is a medical professional who supports both the physician and the patient by meeting previously established goals. This research presents and analyzes the key roles of a health coach in a primary care practice.     

The Role of Business Impact Analysis and Testing in Disaster Recovery Planning by Health Maintenance Organizations

The cost of healthcare in U.S. is a poor value proposition. One of the primary goals of the healthcare reform act is to reduce cost while improving healthcare quality. We believe that adding a health coach will help in achieving this goal. The health coach is a medical professional who supports both the physician and the patient by meeting previously established goals. This research presents and analyzes the key roles of a health coach in a primary care practice.     

新医改形势下医院思想政治工作的探讨

随着医药卫生体制改革的不断深入,特别是新医改方案的出台,我国的医药卫生事业发展已进入到关键时期,在这样的背景下,医院思想政治工作面临着新的课题。该文结合医院工作实际,探讨医院思想政治工作,为新医改的顺利实施提供有力保证。     

The economics of primary healthcare reform in Australia - towards single fundholding through development of primary care organisations

Objective: A strong primary care sector is widely acknowledged as a fundamental component of a well functioning health system and thus has been the focus of strategic reforms in a number of countries. This paper provides an economic analysis of primary healthcare reform, with the aim of identifying the key structural elements that are necessary to support enhanced models of primary health in the Australian context. Approach: This paper utilises economic theory, and draws upon empirical evidence and international experience to analyse primary healthcare reform to identify the structural elements necessary for an enhanced primary care sector. The aim of which is to improve health system performance. These structural elements are then critically examined in the Australian health system setting. Conclusion: For enhanced models of primary healthcare to promote efficiency, they must incorporate a number of key structural elements; notably: governance and purchasing responsibilities for primary care devolved to a meso‐level organisational structure through capitated single fundholding arrangements; blended payment methods for reimbursing providers; the establishment of a national quality and performance framework; and the development of primary care infrastructure. Implications: As the Federal government attempts to address recommendations of the National Health and Hospital Reform Commission, a window of opportunity now exists to pursue long overdue structural reforms to deal with the challenges facing the Australian health system. The paper advances the important structural features to primary healthcare that need to be embraced as the government attempts to pursue its health reform agenda.     

Evaluation and Treatment of Depression (Part I)

Depression is one of the leading causes of disability worldwide, contributing to high medical expenditures, poor clinical outcomes, low productivity, and compromised quality of life. Efficacious treatments are available for the treatment of depression across a broad age range (children/adolescents to elderly). Care management initiatives that include these promising interventions ameliorate the impact of the disorder among patients receiving mental health services in primary care and behavioral healthcare settings. Part I of this two-part article series provides the reader with an overview of issues related to improving the treatment of depression. The approaches used to treat depression and strategies employed to evaluate treatment success are critical. Disease management is one strategy used for improving depression treatment that benefits the consumer and yields positive results for providers and payors.The most effective strategies are those with multiple components, including patient education, coordination of care between primary care and mental health specialists, and ongoing evaluation and feedback. Although the benefits of such interventions are profound in producing improvements in depressive symptoms, social and emotional functioning, and overall satisfaction, there have been few healthcare systems that have successfully integrated such programs into routine care. Despite indirect advantages to providers and payors, the costs of implementing such programs may present a larger barrier to system-wide adoption of disease management for depression. Certainly, the potential for healthcare cost reductions needs to be systematically examined, particularly the extent to which certain patient groups (the most interesting being those with the highest healthcare costs or catastrophic outcomes of their depression) will benefit from disease management programs. Subpopulations (e.g. children, adolescent and older adults) have associated extant barriers that impede progress with implementing disease management support services and programs.Part II provides an overview of quality improvement strategies demonstrated to be effective in improving depression treatment and discusses examples of programs implemented in various care settings.     

以社区为导向的初级卫生保健：比利时社区卫生服务案例分析及启示

比利时的社区卫生服务模式对我国社区卫生服务改革具有借鉴意义。在对比利时一家典型的社区卫生服务中心进行现场考察和案例研究的基础上,总结了其开展社区卫生服务的做法：虽然存在缺乏首诊制度和沟通协调方面的问题,但以社区为导向的多学科协同服务和按人头付费的支付方式改革等做法成效显著。针对我国社区卫生服务改革中存在的问题,提出相关的政策建议,包括建立和完善法律、政策和制度设计;加强多学科的服务团队建设,推动医学模式在社区转变;完善医保配套政策支撑与激励;以社区需求为导向开展跨部门行动,引导社会资源整合。     

医保制度对重点人群保护机制的国际经验

我国医保覆盖面和保障程度在不断提高,但对于重点人群的保护效果却不甚理想。本文简要介绍了德国、日本、韩国和我国台湾地区医保制度,重点阐述了这些国家和地区在防范重点人群医疗支出风险和医保费用监督管理方面的经验,如设置诊次固定缴费额度和（或）医保自负费用封顶线、加大重大疾病人群的医疗费用补助力度等,以期对我国医保制度改革提供借鉴。