德国等九个发达国家区域卫生规划的经验与启示

德国、英国等9个发达国家的经验表明,对医疗服务能力进行区域卫生规划,以提高资源配置效率、满足多层次医疗服务需求、控制医疗费用的膨胀,是国际通行的做法;规划一般由中央政府制定原则,由区域政府（州／省）参与并负责执行;以社会医疗保险为主的国家侧重全社会的服务能力规划,而以国民卫生服务为主体的国家则侧重对公立医疗卫生体系的规划。这些经验对我国在新一轮“医改”中进一步推动区域卫生规划具有重要借鉴意义。     

整合医疗 提质增效

<正>整合型医疗卫生服务体系,是一种体系完整、分工明确、协作密切、功能互补、服务优质的医疗卫生服务体系,对于持续提升医疗服务质量和运行效率,促进医疗卫生服务体系提质增效有着重要作用。近年来,我国一直致力于建设整合型医疗卫生服务体系,并不断加强国际合作,为体系建设提供更多支持。2017年,世界银行贷款中国医疗卫生改革促进项目方案在我国实施,项目主要内容为深化公立医院改革、推进分级诊疗制度和加强医     

不同层次医疗机构资源配置的实证研究

构建新型合理的医疗服务体系是当前制定和实施区域卫生规划的重要内容。要使其发挥医疗卫生资源有效配置的作用 ,必须遵循医疗服务市场的经济规律 ,即引入生产力的概念 ,研究医疗服务系统 ,并要考虑医疗服务市场的特殊性[1] 。医疗服务市场不同于一般的商品交换市场 ,医疗服务市场的特殊性主要表现在医疗服务在经济学上的特殊性。医疗服务是以服务形态存在的劳动产品 ,其生产和消费是同时发生的。它的消费和生产不可分 ,在数量、质量、时间和空间上具有同一性。医疗卫生资源的配置应根据就医的方便程度、需求层次和数量确定 ;医疗卫生资源的…     

关于《医疗机构设置规划》若干问题的探讨

《医疗机构设置规划》是设置和审批医疗机构的依据，体现了医疗卫生服务的公平性，可以提高医疗卫生服务的效率，是医疗管理法制化的重要步骤，是社会经济改革总体规划的组成部分，而且将对建立健全农村三级医疗预防保健网发挥积极作用。《规划》应体现卫生服务的公平性，有利于建立健全医疗服务体系，体现卫生服务的效益和效率原则，体现卫生服务系统的发展，应立足于基本医疗卫生服务，体现中西医并重的卫生工作方针，并在政府领导下，统一布局。文章还论述了《规划》与区域卫生发展规划、社会经济发展规划、社会主义市场经济体制的关系，阐述了制定《规划》的基本步骤和方法，讨论了目前存在的问题和对策。     

台湾地区医疗服务体系管理的经验和启示

本文首先介绍了台湾地区卫生行政管理架构与医疗服务体系的基本情况,重点分析了台湾地区医疗服务体系管理的做法及特点,主要包括通过实行"医疗网计划",合理配置医疗卫生资源;发挥健保制度和医院评鉴的协同作用,规范医疗机构行为;通过"公办民营"提高公立医院效率,以公私平等政策鼓励社会力量办医;严格公立医院运行管理等。最后,提出了对我国加强医疗卫生服务体系规划管理的启示。     

医疗卫生服务体系整合：国际视角与中国实践

为应对老龄化和医疗卫生服务体系碎片化等挑战,许多国家和地区开展了不同内容和形式的医疗卫生服务体系整合改革,内容上主要包括服务提供、治理机制、组织管理和筹资支付等方面,形式上可分为水平和垂直整合、虚拟和实体整合等模式。新医改以来,我国一些地方,尤其是公立医院改革试点城市,在医疗卫生服务体系整合方面进行了改革实践。这些做法各有特点,主要有政府主导是目前整合的主要改革动因;以技术为纽带的虚拟整合简便易行,形式灵活;委托管理或联合体式的整合涉及资产的管理,一体化程度较高;联合兼并式的实体整合具有更强的资源配置能力。但目前我国医疗卫生服务体系整合还存在诸多障碍,如政府分级管理体制、公立医院单体扩张需求、公立医院与基层医疗卫生服务机构衔接、患者自由流动意愿与医保自由就医政策等。应对的主要策略有,注重发挥政府行政调控与市场机制结合的双重作用,因地制宜、循序渐进推动整合,通过改革支付制度等多种方式建立激励机制,有赖于公立医院改革的进一步深化等。     

医改济民生,和谐促发展——我国医改30年回顾与展望

医药卫生体制改革是重大的民生工程。我国30年的医改历程,在建立完整的卫生体系、增强疾病防治能力、提高居民健康水平等方面取得巨大成就的同时,也存在着一些问题和矛盾,究其原因,主要是由于卫生事业性质模糊、政府责任弱化、医疗卫生服务市场化过度、卫生服务的提供与消费两极分化等造成的。新医改方案,从我国国情和现阶段发展水平出发,借鉴国际经验,通过加大政府投入、加快医疗保障制度建设、建立国家基本药物制度、健全基层医疗服务体系和公共卫生服务体系、推进公立医院改革等措施,满足居民的基本卫生服务需求,改善民生,构建和谐社会,而其中强化政府责任、统筹协调各方利益、明确卫生事业的"公益性"、推行新型区域卫生规划,是医改取得成功的关键。     

江苏省常州市区域医疗机构服务协同案例分析

目的:分析常州市区域医疗机构服务协同的背景、主要做法和实施效果,总结典型经验,为推进整合型医疗卫生服务体系建设提供借鉴和参考。方法:运用定性访谈方法收集资料,基于管理协同理论对资料进行分析。结果:常州市通过市级层面统筹建设医疗联合体,建立信息共享平台,推动医联体内部资源整合,建立问题反馈机制等措施初步实现了区域医疗机构服务协同。结论:市政府制定政策统筹推进、促进信息互联互通和医联体内部资源整合有力促进了区域医疗机构服务协同,但仍存在协同程度不紧密,利益分配机制不完善等问题,建议扩大紧密型区域医疗服务协同实施范围,进一步完善利益分配政策。     

应加大对医疗资源配置调控的力度

实施医疗卫生发展与资源配置规划,是构建与国民经济和社会发展水平相适应,有效、经济和公平的卫生服务体系和管理体制,改善和提高卫生综合服务能力和医疗资源利用效率的重要举措,是政府的重要职责之一。如何科学合理地进行医疗卫生资源的优化配置,提高利用效率,使其更好地     

日本私立医疗服务机构及相应政府职能简介

通过对日本私立医疗服务机构的发展历程、现有数量与规模、服务功能、经营状况等进行介绍,揭示了私立医疗机构在日本医疗服务体系中的地位及其对整个国家卫生系统绩效的贡献.同时,介绍了日本政府对私立医疗服务机构进行培育和监管的相关职能,并重点介绍了政府如何通过制定规则和举办公立医疗服务机构来参与竞争,确保私立医疗服务机构的健康成长.由此探讨我国的医疗卫生改革如何借鉴日本的经验,充分运用市场机制和政府职能的调节手段,提高我国医疗资源的运营绩效.     

厦门市某医院战略规划制定研究概述

医院实施战略管理，可有效分配人力和物资资源，提高医院运行效率和服务质量，降低医疗费用，满足人民群众日益增长的医疗需求。作者阐述了医院制定战略规划的意义，描述了厦门市某医院制定战略规划的背景、过程及资料收集方法，并通过对其内外部环境进行分析，确定医院的方向性战略，做出医院未来10年的战略规划。在制定医院战略规划的过程中，提出医院愿景、建立医院战略目标体系和制定战略方案是战略规划的实质。     

上海市某区志愿服务现况调查

目的调查上海市某区卫生计生系统志愿服务现状,为促进志愿服务的规范化、常态化发展提供依据。方法采用问卷调查法及关键知情人访谈法,对全区卫生计生系统28家机构开展全标本横断面调查,运用STATA 13.0软件建立数据库并进行统计学分析。结果28家均开展志愿服务工作,人员构成主要有系统内职工及社会爱心人士。志愿者管理措施有制定管理制度、年度计划、激励措施、志愿服务培训,开展的志愿服务有啄木鸟巡查、控烟宣传、导医导诊、健康宣教、医疗义诊、应急保障等。志愿服务管理过程中存在缺乏制度保障、信息化程度不高、志愿者积极性不高等问题。结论志愿服务已广泛开展,建议优化志愿服务项目,提升服务效能;完善激励机制,提高志愿者积极性;建立信息化平台,提升管理精细化水平。     

在国家治理体系框架下加强医药卫生体系治理能力的建设

医药卫生体系的治理是国家治理的重要组成部分。在推进国家治理体系和治理能力现代化的总体目标下,应构建系统完备、科学规范、运行有效的医药卫生制度体系。为加强我国医药卫生体系的治理能力建设,本文从医疗保障体系、医疗卫生服务体系和药品供应保障体系三个方面,提出了必须坚持和巩固的根本点以及相关政策建议。     

论深化医改进程中分级诊疗体系的完善

分级诊疗作为深化医药卫生体制改革的的产物,是实现有序就医的重要制度保证。目前实施分级诊疗还存在许多壁垒,必须在医药卫生体制改革过程中,通过解决医疗机构体制机制僵化、明确各级医疗机构的职责与权限、制定满足人民群众对医疗服务需求的区域卫生规划、完善政府对公共卫生服务的补偿机制和医疗保险相关政策等问题,逐渐达到医疗服务层级化。文章介绍了分级诊疗的理想模式,分析了分级诊疗的准备过程,提出了促进分级诊疗健康成长的对策。     

武警卫勤指挥作业系统的研制

目的：丰富院校卫生勤务学的教学手段,提高基层部队卫勤机构的组织指挥能力。方法：借助现代信息技术,以武警卫生勤务业务为主要内容,采用组件化开发的方法。结果：成功研发武警卫勤指挥作业系统,该系统包含卫勤标图、减员预计、保障能力分析、卫勤保障预案检索和卫勤文书拟制等5个部分,可以实现要图标绘、正确预计减员情况、正确分析保障能力、快速查找常用卫勤保障预案以及拟制常用卫勤往来文书的功能。结论：武警卫勤指挥作业系统既可满足院校卫勤组织指挥教学的需要,又可指导基层卫勤机构展开模拟训练,提高军事行动的卫勤保障能力。     

Developments in immunization planning in Cambodia--rethinking the culture and organization of national program planning

INTRODUCTION: As part of its health system reconstruction following decades of civil war, Cambodia undertook a program of health sector reform in 1996 to expand coverage of essential health services to the population of 14 million, 80% of whom are resident in over 13 000 rural villages. During this reform period, one of the major national health programs, the National Immunization Program (NIP), adapted its planning system to accommodate changes in social and health sector structure. Aims: The aims of this article are to review changes made in the approach to national immunization planning and to illustrate how these adaptations can help identify future challenges and opportunities for further improving immunization coverage in Cambodia. Sources of information for the study include immunization plans and data from international and national sources, as well as data from the national health information system. Findings of review: Management and service delivery reforms undertaken by the NIP include (1) strengthening links between immunization, health sector and international health planning; (2) development of immunization program multiyear and financial sustainability plans; (3) strengthening of national program decision making structures and processes; (4) widening of decentralized stakeholder participation in health planning; and (5) implementation of service level micro-planning. Outcomes: These management reforms have been associated with significant improvement in public health program performance and outcomes during this period (2003-2006). There has been an increase in vaccination coverage for children under the age of one year, over a five-year period (increase of 29% for fully immunized child at one year of age), with no significant differences in vaccination rates between urban and rural areas, and a sharp decrease in the incidence of vaccine preventable diseases. CONCLUSION: The NIP is now well positioned to take on additional challenges in coming years associated with expanding international partnerships, the continued development of civil society, further health system decentralization, and the requirement to further improve coverage in support of global and regional disease elimination goals. However, as costs continue to rise, planners in the future will need to emphasize the economic and public health benefits of immunization programs in order to sustain increasing levels of national and international investment.     

Planning and management of public health in the federal republic of germany

In the Federal Republic of Germany, the debate on public health is dominated by the question as to the cost and the financing of good health care. Indeed, expenditure planning has now become the main area of planning in the public health sector. By contrast, the plans to improve health standards and to intensify health protection as well as to improve the quality and efficacy of health provision are somewhat neglected. This is probably due, in the main, to the strong position held by the providers of medicines and medical services and thus, by the same token, to the weak position of the consumers.Although there exists a well known set of statistics and indicators to describe the state of public health in this country, there is an almost complete absence of any attempt to evaluate them for planning purposes. The scope of intervening in the sphere of health care is thus left to a large number of protagonists characterized by completely heterogeneous interests. What we lack is a system of target-oriented plans and concrete measures. In the field of providing health care and combating disease, the only available systematic planning concerns the provision of in-patient and out-patient medical services: there is no planning for the quality of such facilities or for the range and quality of psychosocial and nursing services. As regards health-expenditure planning - which has made the biggest advances - the participants enjoy a great deal of independence: the volume of spending and increases in expenditure are thus the outcome of a process of negotiation. Under the current planning philosophy, consensual decision-making enjoys a high status.     

Micro-level planning using rapid assessment for primary health care services

This paper describes the use of a rapid assessment technique in micro-level planning for primary health care services which has been developed in India. This methodology involves collecting household-level data through a quick sample survey to estimate client needs, coverage of services and unmet need, and using this data to formulate micro-level plans aimed at improving service coverage and quality for a primary health centre area. Analysis of the data helps to identify village level variations in unmet need and develop village profiles from which general interventions for overall improvement of service coverage and targeted interventions for selected villages are identified. A PHC area plan is developed based on such interventions. This system was tried out in 113 villages of three PHC centres of a district in Gujarat state of India. It demonstrated the feasibility and utility of this approach. However, it also revealed the barriers in the institutionalization of the system on a wider scale. The proposed micro-level planning methodology using rapid assessment would improve client-responsiveness of the health care system and provide a basis for increased decentralization. By focusing attention on under-served areas, it would promote equity in the use of health services. It would also help improve efficiency by making it possible to focus efforts on a small group of villages which account for most of the unmet need for services in an area. Thus the proposed methodology seems to be a feasible and an attractive alternative to the current top-down, target-based health planning in India.