欧洲卫生改革：共识基础上的整体推进

基于WH0欧洲委员会“增加财富与增进健康的卫生系统——塔林宪章”的卫生改革框架,该文从卫生服务供给和卫生筹资2个方面系统介绍了欧洲国家近年来所实施的改革政策与措施。通过强调转变卫生服务模式,加强慢性病管理,提高卫生系统的反应性,改善卫生服务的质量,加强公共卫生、疾病预防和健康促进,以及加强卫生人力资源建设等关键措施来完善卫生服务供给模式;通过增加公共财政投入、建立多元化的筹资模式和风险分担机制、维护医保制度的稳定性、提高统筹基金的抗风险能力、采取卫生服务购买模式以及改变支付方式来加强政府卫生筹资。这些为我国深化卫生改革提供了许多可以借鉴和学习的经验。     

卫生筹资与卫生系统绩效之间的关系及对中国的启示研究

目的:探索卫生筹资对卫生系统绩效的影响,为筹资模式的设计提供依据.方法:以经济合作发展组织(OECD)29个国家为研究样本,将其筹资模式分为税收与社会保险筹资两种方式,采用多元线性回归模型,构建卫生筹资模式及有关变量与卫生系统绩效间的回归模型.结果:税收筹资模式国家的卫生系统绩效总体优于社会保险模式的国家.政府卫生投入、卫生支出、GDP等筹资指标与卫生系统绩效正向相关.结论:税收筹资模式能更好地改善卫生系统绩效.中国卫生筹资应优先考虑税收筹资制度.     

印度尼西亚卫生系统面临的主要卫生经济问题及改革取向

在分析了印度尼西亚医疗卫生服务提供系统和卫生系统绩效基础上,展示了印度尼西亚卫生系统面临的主要问题和挑战。其中,包括慢性病疾病负担沉重、医疗服务和资源分配不均、农村卫生服务可及性较差以及政府卫生筹资比例较低等。目前印度尼西亚卫生系统的改革取向是实现公平和自治目标,通过社区和私立部门以及公民的参与,实现公平的卫生服务和卫生资源的可得性,增强卫生服务体系,改善公民健康。     

欧洲各国基于问责制的卫生系统绩效评估

通过改善卫生系统绩效以获得最大健康效益是每个国家卫生改革与发展所面临的首要问题,欧洲各国通过建立相关的问责机制,采取明确权责和促进落实等具体措施,推动和促进了卫生系统绩效评价的实施与发展,这也为我国开展卫生系统绩效评估提供了许多可以借鉴和学习的经验。     

疾病预防控制机构组织绩效评估实证研究

近年来,政府行政绩效以及公共财政支出绩效越来越受到关注,人们的探索也同样投入到公共卫生领域〔1〕。卫生政策制定者开始关注各自卫生系统的绩效,许多国家进行了旨在改善绩效的改革〔2-3〕。作为卫生系统重要的组成部分,疾病预防控制机构承担大量的公共卫生服务,其绩效评估越来     

我国卫生服务系统绩效分析

以世界卫生组织(WHO)提出的卫生服务系统绩效评估框架为目标，以世界银行提出的卫生系统诊断工具为分析手段，对导致我国现阶段卫生绩效的结果、成因以及改善的办法与途径进行了系统分析，指出为改善我国现阶段卫生系统总体绩效不高的现状，必须要坚持公平优先、兼顾效率的原则，进一步改善基本卫生服务的可及性，提高卫生服务系统对人民群众普遍、合理期望的反应性。     

政府卫生事业投入分析

目的：了解政府对卫生事业财政投入的现状及问题，为提高卫生系统绩效及制定与改革卫生政策提供依据。方法：利用卫生总 和的筹资来源法和机构法计算全国、甘肃省及榆中与和政两县政府卫生投入。采用平减指数法对财政支出与政府卫生投入增长率进行分析。结果：目前我国政府卫生投入量逐年下降，机构分布不合理，城乡差别大，效率低下。结论：政府有关部门应重视对卫生事业的投入并进行相应改革；尤其应调整投入结构，增加投入力度，加强公共卫生投入；提高资金的使用效率，为保障人民健康，提高人民健康水平，发挥政府部门应尽的责任。     

世界卫生组织重申国家卫生政策、战略和计划的重要性

近日,世界卫生组织重申了国家卫生政策、战略和计划的重要性,认为其本身并不是目的,而是卫生进程的重要组成部分。为了更好地利用卫生资源、使所有人都获得高质量的卫生服务,需要将国家卫生重点与居民卫生服务需求相结合,推动政府、卫生合作伙伴、社会团体以及私营业主的共同参与。由于目前卫生系统绩效的改善程度难以满足日益增长的卫生服务需求,因此各国政府加强了卫生政策、战略和计划制定的能力,以实现以下目标：（1）对日益增长的卫生服务需求做出反应,通过初级卫生保健加强卫生系统,实现人人享有卫生保健的目标;并需要采取以下政策行动：迈向全民覆盖,以人为本调整常规卫生服务方向,将卫生纳入所有政策,增强卫生治理的包容性。（2）引导和推动卫生部门职能的多元化,而不仅是制定和实施卫生规划。（3）超越卫生系统之外来解决卫生问题,并实现卫生部门和其他部门的良性互动。     

卫生投入公平性实现路径探讨

新医改方案明确了基本医疗卫生制度的公共产品属性,围绕着坚持公共医疗卫生的公益性、促进公平公正,需要进一步强化政府的职责,完善政府卫生投入机制。该文试图从卫生投入应遵循的原则和依据出发,提出确保公共卫生投入的公益性、建立健康导向型疾病预防模式、形成财权和事权相匹配的政府卫生投入机制、明确政府职能和责任边界、科学界定公共卫生服务与基本医疗服务的内容及范围等路径,为政府的卫生投入落到实处提供借鉴。     

健康、技术、改革与发展的关系

该文论述了健康与发展的关系，技术与卫生发展的关系，改革与卫生发展的关系。指出卫生系统的组织和筹资策略是保证人人享有卫生保健的重要手段，保障人民健康是政府的责任；政府对社区医疗服务的质量和公平性应该加强监督与立法；只有改变卫生服务提供方（医院、医师）的行为，将改革支付方式作为改革的重点，才能取得控制费用和改善健康的双重效果。     

Ecosystem health and human health

The study of ecosystem health is a relatively recent discipline that has already provided new insights into numerous aspects of environmental management. One of the most interesting fields of study is the one investigating the relationships between ecosystem and human heath. In this paper some basic terms of reference are given in order to help the understanding of this new approach. One definition of ecosystem health is given, possible causes of degradation are indicated and links with human health are addressed. The ecosystem approach to human health stresses the importance of cultural and social values in shaping the concept of health, both at human and at ecosystem level. Two case-studies showing man-ecosystem interactions are described: mining activities, that provide a suitable field of application of the ecosystem approach, and the case of malaria and DDT, that shows the risks of certain policies neglecting basic human expectations such as health. As a conclusion, some suggestions for possible research activities are given and a few recommendations for sound public health policies are indicated.     

Communicating health through health footprints

The depth and scale of challenges posed by noncommunicable diseases such as diabetes mellitus and cardiovascular disease are now well known and clearly documented. Reducing the 4 key risk factors has been shown to reduce premature mortality and morbidity by 70% globally. The authors consider how affirmative action can be driven to reduce these risk factors through Health Footprints, targeted interventions within specific domains of consumption, on the basis of an assessment of the negative health effect of specific choices, with the goal of driving healthy choices and improving health. In this article, the authors propose a methodology that ties together insight from public health, behavioral economics, marketing, and health communication. They offer 3 specific examples for affirmative action: a Pigovian tax on unhealthy foods, group-level interventions on the basis of sharing key health data, and personalized prevention tailored to specific individuals. In addition, they discuss the approach to implementation, including the role of an apex coordinating organization in setting standards for data and ethics, and evaluation of the effect of interventions to drive continuous improvement.     

Community health and foot health

The limiting factor in health and mobility for many seniors is the state of their feet. The origins of their foot problems can often be traced back to childhood and years of wearing badly fitting or inappropriate footwear. Well-fitting footwear is essential if mobility and independence are to be retained. The chiropodist (or podiatrist) is a health professional specializing in the treatment of conditions of the foot. Some common foot conditions, together with their treatments, are described. Although numbers of chiropodists in Canada are limited, their role is being increasingly recognized in maintaining or restoring mobility, and also their place in the community health team.     

Oral health and systemic health

Certain cancers, hypertension, diabetes, leukemia, gastrointestinal disorders, osteoporosis, and HIV and other infectious diseases can manifest themselves in the oral cavity. In addition, some of these conditions and the therapies for them can affect the teeth and mouth. This article outlines what physicians should know about how certain medical conditions and medications can affect dental health and treatment, how dentists can help detect underlying medical conditions, and how the two professions can better serve patients by working together. placement of implants, periodontal surgery, endodontic treatment, or subgingival manipulation. Physicians should be aware of potential complications from dental treatment, inform patients of the risks, and communicate to the patient's dentist about the patient's physical status, the extent to which his or her condition is under control, and how to prevent complications. The following examples illustrate the need for such interaction between physicians and dentists.