试论社会主义医疗卫生服务市场

医疗卫生服务市场是社会主义市场经济体制中的一个特殊市场，它有着与其它市场所不同的特征和特点。要正确把握医疗卫生服务市场的基本规律和特点，找出符合我国社会主义初级阶段下，医疗卫生服务市场的运行轨道，以满足社会不同经济阶层对医疗卫生保健的基本需求。     

卫生人力与三个市场

卫生人力的产出和需求牵涉到三个市场、两个接口、两个过程。所谓的三个市场就是医学教育市场、卫生人力市场和卫生服务供给市场 ;两个接口就是医学教育出口和卫生人力市场入口间的接口以及卫生人力市场出口和卫生服务供给市场入口间的接口 ;两个过程就是医学教育过程和卫生人力的需求实现过程。如果它们间运转不畅 ,就会影响到卫生人力与三个市场的合理关系 ,并造成卫生资源的巨大浪费。一、卫生服务供给市场与卫生人力(一 )卫生服务供给者垄断卫生服务供给市场是一个特殊的市场 ,存在着垄断现象。一为进入障碍 :由于卫生服务需求的有限性…     

政府与市场的定位

中国医疗卫生的发展与改革工作进入一个关键时期所碰到的一个关键性理论与实践问题是,如何把握好政府与市场在医疗卫生领域里的定位。无论是笼统地谈"政府主导"还是笼统地谈"市场主导",都是一种偏见与误导。两者在医疗卫生监管、医疗卫生服务、医疗卫生资源提供、医疗卫生保障这四个"子系统"中具有不同的作用。我们需要着重探讨如何在落实"全民基本卫生保健"的筹资保障和服务提供方面,将政府干预与市场机制有机地结合起来进行制度创新。     

健康服务特性与医疗卫生的两种可推动机制

医疗卫生服务包括对身心处于健康的人群给予健康维护和促进、对疾病的发生进行预防以及对身心处于发生疾病的人群给予治疗和护理。作者在分析了卫生服务和医疗服务的经济行为特征之后提出，卫生服务能被公共服务机制所推动，而不能被交易机制所推动；大病医疗服务能被交易机制所推动，而不能被公共服务机制所推动。社区医疗具有特殊的保障意义，只能在公共服务机制下才能被推动。建议兼顾两者的效率，组合两种机制，构成完整的面向全面健康的复合型保障机制。     

刍议医疗服务市场

在社会主义市场经济体制下，医疗服务如何适应新形势．怎样转换与接轨，正是医院管理者亟待研究的课题。一、医疗服务市场是客观存在的医疗卫生服务有着挽救生命、保障人类社会正常发展的重要作用．医疗卫生服务既具有高度的人道主义性质．又表现为一种特殊的商品性。在社会主义市场经济体系中也包含着医疗服务市场，并与其它市场共同用成一个统一的、完备的市场体系．医院管理者们必须认识到医院要真正更好地为经济建设和人民健康服务．跟上时代步伐，就必须彻底更新观念。可以预见，随着卫生改革的深入发展．医疗服务市场将逐步发育，趋于…     

经济学与卫生经济现象异构探究

经济学分析对象是一般经济行为,而医疗卫生经济是特殊经济现象。医疗卫生经济的特殊性表现在其行为的社会价值目标与一般经济不一样,交易特征与一般经济不一样。医疗卫生的社会价值目标是健康福利的提高,经济学的分析目标是经济福利最大化,这是目标的差异;医疗卫生服务的交易特征具有不完全性和交易者与交易物的自我缠绕,而经济学研究的交易特征是完全的交易和交易者独立于交易物之上,这是交易特征的差异。由于这样的差异,使经济学分析逻辑框架与医疗卫生经济事件之间内在逻辑联系存在异构。由于存在异构情况,经济学对医疗卫生经济现象的解释与认识不能反映事物发展的本质特征。医疗卫生的经济分析需要新的工具。     

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。     

城市流动人口卫生服务需求调查分析

本文通过对599名来京务工人员的两周和一年内病伤情况进行调查,说明城市特殊劳动人群的医疗服务需求是比较高的,为了适应和促进当前经济体制改革的形势,对城市中的流动人口的医疗卫生服务问题应进行深入研究,并采取相应的必要措施。     

医疗卫生服务市场中政府作用的特点

医疗卫生服务市场是一个特殊的市场 ,因此 ,医疗卫生服务市场中的政府作用有着特定的要求 ,使它既区别于传统计划经济体制下的政府作用 ,又与国民经济其他部门的政府作用有重大差别。一、有别于传统计划经济体制下的政府作用随着医疗卫生服务市场的放开 ,政府对医疗卫生服务活动作用的力度、方式、范围等均发生了变化 ,这种变化的显著特点就是一个“小”字。因为在市场经济条件下 ,卫生资源配置的主体已由单一的政府部门向政府和市场共同配置转化 ,因而在医疗卫生服务领域 ,政府的角色功能与传统计划经济时代已不可同日而语。在计划经济体制…     

英美两国卫生资源配置的制度经济学解释

从制度经济学“交易”的概念入手,分析了买卖交易和限额交易的特点,并用不同形式的交易理论,解释了以限额交易为特征的英国国家卫生服务体制、以买卖交易为特征的美国医疗服务市场体制,在医疗费用控制等制度绩效方面的差异.这对我国的卫生改革具有参考价值.     

Repair for a broken market: the medical service company

Sky-rocketing costs are fueling debate over whether market mechanisms can work for the healthcare services industry. The market for health care certainly seems to be broken. Value is decreasing, services are fragmented and costly transactions among providers are exacting a great toll in efficiency and service. Perhaps ironically, this situation presents a golden opportunity for providers who understand that the market is merely responding to the combined stimuli of inflated demand and excessive regulation. We believe that Medical Service Companies, which unite physicians and hospitals under one corporate roof, can reduce market friction, improve the responsiveness of providers and provide better value than traditional provider organizations.     

What kind of healthcare ‘internal market’? A cross-europe view of the options

Many governments are trying to invent new types of 'internal' healthcare market that will expose health services to competitive pressures to innovate, contain costs, raise service quality, and respond better to consumer demands; but not expose them to 'market failures' which prejudice universal access to 'basic' health services. Policy debates in this area are muddled and constricted by a failure to differentiate the variants of internal market that are available. This article outlines a taxonomy of the main types of internal market: primary doctor purchasing; managed competition; competitive bidding; social insurance; and compulsory private insurance. It notes their main structural characteristics and differences. Although internal market reforms have been intended to support the commercialization of healthcare, the idea of designing new types of economic structure to avoid market failure in healthcare has wider and more radical implications than most policy-makers intend.     

上海市虹口区家庭医生签约服务需求及影响因素分析

目的:分析居民对家庭医生"1+1+1"签约服务的需求状况及需求结构,探索需求差异的影响因素,为提供有吸引力的签约服务提供政策依据。方法:在上海市"1+1+1"签约试点区虹口区欧阳路街道开展问卷调查,采集有效样本1 745份;对服务需求指标进行探索性因子分析。结果:居民对签约服务的需求目前主要集中在配药服务上;将20项需求指标合成为3个公因子,个性化服务需求、基本医疗服务需求、健康管理服务需求,其主要影响因素分别包括性别、健康状况、就医行为与满意度,健康行为与满意度,婚姻与综合满意度。结论:药品需求仍然是居民当前最为主要的需求,不同特征的居民存在签约服务的需求差异;有必要针对不同人群提供个性化的、切实需要的签约服务,这样才能维持稳定的签约关系、引导居民下沉就诊、构建有序有效医疗服务体系。     

Health reform planning models. The case of veterans hospitals

As part of the national effort to reform healthcare, the Department of Veterans Affairs is undergoing a major reassessment of its healthcare mission. As Veterans Affairs prepares to meet the challenges of the twenty-first century, one underlying issue of critical importance is which planning assumptions will be selected and employed. Will historical patterns of veterans' use be interpreted as indicators of the market demand for Veterans Affairs healthcare services, or will estimates of disease prevalence among veterans be used as indicators of future healthcare need? If Veterans Affairs is to continue as a critical component of the nation's healthcare delivery system, its selection of a planning basis will have major implications for tomorrow's healthcare system.     

中国医疗市场需求分析与短期预测

本文利用1992年、1997年以及2002年医疗总费用测算结果，描述中国医疗市场需求现状及总体趋势，并就年龄别、疾病别医疗费用进行回顾性分析。在此基础上，对中国医疗市场需求作短期预测，并阐述医疗市场需求快速增长的主要原因。     

Medical tourism in emerging markets: The role of trust,networks, and word-of-mouth

Despite the growing popularity of medical tourism (MT) in emerging markets (EMs), little is known about how healthcare providers operationalize. This article analyzes how healthcare providers meet different challenges to market MT in an EM setting. A qualitative method was used for data collection and conducting case studies on healthcare services in the Philippines. The results show that trust and network building are necessary for mitigating the unfavorable characteristics, instability and lack of legitimacy caused by institutional constraints in EM. Word-of-mouth is found to be important to attract new customers and disseminate information about MT services.     

Vouchers for primary healthcare services in an ageing world? The perspectives of elderly voucher recipients in Hong Kong

Considering the ageing population in economically advanced regions across the world, measures are necessary to enhance the health of the older population as well as contain public healthcare spending. Hong Kong implements the Elderly Health Care Voucher Scheme (EHCVS), providing older people aged 65 or above an annual subsidy of visiting private healthcare service providers for chronic disease prevention and management. The services also aim at reallocating demand from the public to private sector as well as improve quality of services. This qualitative study explored the experiences of EHCVS recipients (n = 55, aged 61–94) with eight focus group interviews in Hong Kong in the year 2016. Convenience sampling was used. Research questions were: (1) Why do older people choose not to use EHCVS for preventive as well as disease management services among older people in Hong Kong? (2) What are the barriers to reallocating demand from the public to private sector? (3) In what ways did EHCVS improve the quality of primary care services for older people? Using a deductive and inductive approach, eight qualitative themes were identified. Findings suggested that the non‐targeted services and inadequate knowledge on EHCVS deterred older people from using the vouchers for disease management and prevention. The relatively expensive private services, lack of trust in the private sector, low public clinic fees and good services quality of the public sector, together with inadequate private practitioners in the healthcare market were barriers that hinder demand reallocation. Nevertheless, the quality of primary care services had been improved after the implementation of EHCVS with shortened wait times and opportunities to discuss health‐related issues with private practitioners. Findings were discussed with practice, policy and research implications.     

Pre-design facilities for change

Medical facilities are changing to meet the demand for convenient out-patient healthcare, and hospitals are clearly following the market to deliver primary care services through ambulatory care facilities. Whether it is a satellite center for a hospital, an out-patient surgical center or any number of other specialty service clinics, a free-standing facility represents a major investment, filled with latent pitfalls.     

中低收入群体医疗服务需求的特点、问题与对策——基于1642户中低收入家庭调查

健康是人类生存和发展的基础,中低收入群体的健康问题和医疗服务需求尤其值得政府和社会的关注。通过对七个省份(直辖市)中低收入群体医疗服务需求的实地调查和1642份问卷的分析,发现了中低收入群体医疗服务需求的特点和存在的问题,如健康状况不容乐观、慢性病发病率高、医疗负担过重等;并提出增加投入、完善基层医疗服务体系、减轻中低收入家庭医疗负担、探索新的医疗服务模式等完善中低收入群体的医疗服务与医疗保障的政策建议。     

满足病人合理需求促进医院全面建设

如何认识和满足新形势下病人的合理需求，是当今医疗机构亟待解决的课题。文章在简要分析医疗消费新特征、依法界定病人合理需求的基础上，结合医院实际，从树立良好医德、提供优势服务、完善服务保障等方面，就市场经济条件下如何满足病人的合理需求，促进医院的全面建设和发展，进行了探讨。