简述卫生投融资改革之目的与意义

章结合对上海卫生投融资体制和医院建设的现状分析，提出加快卫生投融资改革具有重要的目的与意义。     

卫生投融资改革的初步设想

长期以来，我国卫生事业一直由政府举办和管理，逐步形成了完全依赖政府的局面。由于筹资渠道过于单一，且政府投资效率低下，卫生事业的发展总是滞后于当地经济发展水平和城市建设规模，与人民群众医疗需求的矛盾日益突出。而另一方面，随着社会经济的快速发展，大量的社会资金迫切需要保值增值的投资渠道，由于医疗卫生的收益稳定，成为社会各方资金投资看好的项目。以慈溪市为例，2003年6月底     

关于卫生投融资改革若干问题的思考

作探讨了卫生系统投融资改革的若干问题，包括政府职能转变，医院资产管理，财务投资，公立医院的补偿机制和医疗保险和投融资之间的关系等。     

谈公立医院的产权制度改革

随着卫生改革的不断深入,产权制度对公立医院的影响无论从深度上,还是从广度上都是空前的,可以认为公立医院产权制度的改革将成为下一步改革的重点.     

公司法人治理结构对医院产权制度改革的启示

作者首先阐述了法人治理结构的内涵与产生，随后就医疗机构独具特色的双重委托代理关系、结构问题应该成为医院放权式改革的重点、公司法人治理结构的基本策略和主要方法及国外医疗行业治理结构相关问题即谁应成为病人的代理如何通过合理的报酬设计使代理人同委托人利益一致等进行描述，最后就治理结构对我国公立医院产权制度改革的启示作了论述。     

产权制度与医院产权制度改革

医院产权制度改革作为理论、政策、运作的实际问题摆在医院管理者和理论工作者面前。故作者在产权制度基本概念中介绍了西方和马克思及我国学者的产权观，随后就法人产权与法人产权制度的内涵进行分述。同时指出了法人产权制度的优点和局限，以及国家基本医疗制度和医院产权制度的关系、医院产权制度与医院行为的关系，最后阐述了中国医院财产权制度可以取3种改革路径。即小改－加强管理代替改革；中改－建立医院类产权制度；大改－建立医院产权制度。     

公立医院的产权制度改革的问题及对策

文章通过对公立医院目前的产权制度运行机制存在的问题及改革的必要性进行分析，提出运用经济型医院治理模式来治理医院，以加快医院改革的步伐，推进医疗卫生体制的改革。     

鼓励多种形式的改革探索

深圳市作为国家公立医院改革试点16个联系城市之一,采取多种形式探索公立医院法人治理结构：一是南山医院的理事会模式。     

Recent issues of the Romanian health financing system

The aim of the paper is to examine the health financing reform in Romania in order to find out to what extent the expected results were achieved, what were the main factors that influenced the reform process and in what way the main unsolved problems are to be sorted out. The paper describes the main features of the health financing reform outlining the factors that determined or influenced it, presents some of the reform outcomes and discusses the current health policy agenda. The main findings of this examination are the following: the expected results of the health care reform were not fully achieved (one of the main causes was the too high expectations that did not take into account the country’s low starting point at the beginning of the transition); the reform process was slowed down mainly by political instability, the funds for health increased over time, but this was not enough to increase health system performance and patient satisfaction, the health system reform finally became one of the main priorities on the government agenda. The paper concludes that it took quite a long time until the Romanian government took over its stewardship role of the health system, with the understanding that health reform cannot be a separate process but rather is in need of intersectorial action, clear and coherent legislative support and strong political backing.     

我国卫生筹资中的问题及其政策选择

通过对我国卫生筹资的研究,总结卫生费用筹集和分配中存在的问题,根据国际卫生筹资经验研究,顺应新医改要求,强化政府责任,健全卫生服务体系,有针对性地提出一些政策建议。     

Health sector reforms in Argentina and the performance of the health financing system

In Argentina, health sector reforms put particular emphasis on decentralization and self-management of the tax-funded health sector, and the restructuring of the social health insurance during the 1990s. Unlike other countries in the region, there was no comprehensive plan to reform and unify the sector. In order to assess the effects of the reforms on the performance of the health financing system, this study looks at impacts on the three inter-related functions of revenue collection, pooling, and purchasing/provision of health services. Data from various sources are used to illustrate the findings. It was found that the introduction of cost recovery by self-managed hospitals increased their budgets only marginally and competition among social health insurance funds did not reduce fragmentation as expected. Although reforming the Solidarity Redistribution Fund and implementing a single basic package for the insured was an important step towards equity and transparency, the extent of risk pooling is still very limited. This study also provides recommendations regarding strengthening reimbursement mechanisms for public hospitals, and regulating the private sector as approaches to improving the fairness of the health financing system and protecting people from financial hardship as a result of illness.     

卫生投入的政府责任分析

从公共经济学角度出发分析了卫生领域政府和市场的作用,根据各类卫生服务的经济学特征和目前的财政体制特点,确定了卫生领域中各级政府的责任。在划分各级政府责任的基础上,结合财政体制的特征,指出政府卫生投入资金要向绩效预算迈进,以使政府卫生投入能够有效使用。     

新医改以来我国卫生筹资的进展、问题与面临的挑战

新医改四年来,我国各级政府大规模增加卫生事业的财政投入,卫生公共筹资体系建设成效显著,然而亦存在一些突出问题,卫生筹资的可持续性面临挑战。当前我国新医改进入“提质增效”的第二季,需要以转变政府管医办医职能为统领,协同配套推进体制机制改革,多渠道增加卫生资源,提高卫生投入绩效,实现卫生筹资的可持续发展。     

Equity, governance and financing after health care reform: lessons from Mexico

To determine, from the perspective of providers, community leaders and users of health services, equity, governance and health financing outcomes of the Mexican health system reform.Cross-sectional study oriented towards the qualitative analysis of financing, governance and equity indicators for the uninsured population. Taking into account feasibility, as well as political and technical criteria, six Mexican states were selected as study populations and a qualitative research was conducted during 2004-2006. Two hundred and forty in-depth interviews were applied, in all selected states, to 60 decision-makers, including medical and administrative personnel; 60 service providers at health centres; 60 representatives of civil organizations, including municipal representatives and, finally, 60 members of health committees and users of services at second and first levels of care units. The analysis of interviews was performed using ATLAS-Ti software. An outcome mapping of health reform was developed. For political actors, Mexican health system reform has not modified dependence on the central level; ignorance about reform strategies and lack of participation in the search for financial resources to finance health systems were evidenced. Also, in all states under study, community leaders and users of services reported the need to improve an effective accountability system at both municipal and state levels. Health strategies for equity, governance and financing do not have adequate mechanisms to promote participation from all social actors. Improving this situation is a very important goal in the Mexican health democratization process, in the context of health care reform. There are relevant positive and negative effects of the reform on equity, governance and financing in health. Special emphasis is placed on the analysis of lessons learned in Mexico and the usefulness of the main strengths and weaknesses, as relevant evidences for other middle-income countries which are designing, implementing and evaluating reform strategies in order to achieve equity in resource allocation, good levels of governance and a greater financial protection in health.     

加拿大卫生改革现状、发展趋势及其对我国的启示

全民医疗保健制度是加拿大卫生体系乃至社会政策的核心,经济起伏下的筹资增减深刻影响到加拿大近二十年卫生发展历程,以公平、公正为基本价值观,构建低成本高效益卫生服务体系,为全民及时提供高质量卫生服务是加拿大卫生改革发展的基本趋势。本文介绍了上世纪后十年和本世纪初十年两阶段的加拿大卫生改革的背景、现状、特征、主题、内容、影响、经验和教训,并从公平、效率和长期性三方面阐述了对我国卫生改革发展的启示。     

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。