卫生与经济协调发展辨议

卫生与经济协调发展是卫生与经济这两大不同范畴系统在发展中的互动、适应、配合与促进。经济发展与卫生发展具有关联性，但不具有必然性，一定程度的卫生发展也不代表已与经济协调发展。卫生与经济协调发展要以政府计划调控为主．实行计划调节与市场调节相结合。实现卫生与经济协调发展必须不断增加对卫生的投入，增加的投入不是单一的经济投入，而是包括经济投入在内的综合投入。     

公立医院设置与发展规划的必要性

《中共中央国务院关于深化医药卫生体制改革的意见》指出，当前我国医药卫生事业发展水平与人民群众健康需求及经济社会协调发展要求不适应的矛盾还比较突出；城乡和区域医疗卫生事业发展不平衡，资源配置不合理，公共卫生和衣村、社区医疗卫生工作比较薄弱，医疗保障制度不健全，药品生产流通秩序不规范，医院管理体制和运行机制不完善，政府卫生投入不足，医药费用上涨过快，个人负担过重。     

参照中国卫生总投入模型调整政府筹资管理内容

卫生发展与经济发展的相对不平衡，是中国卫生事业管理中存在的主要问题．加大投入是解决目前卫生发展问题的关键途径。通过分析1978-2003年的中国卫生投入修正后数据，建立了影响中国卫生事业总投入变化的因素的回归模型，然后对卫生筹资管理进行了评价。结果显示，中国的卫生总投入年平均增长速度要达到21．04％，才能在“十一五”末达到WHO要求的占国内生产总值的8％的最低标准；应该将加大政府的投入作为工作重心：增加卫生投入不会影响经济的发展，而是一个扩大内需的途径。建立可控性良好的卫生费用酬资机制，是保证卫生事业持续发展的长久大计。     

对当前二级医院可持续性发展的思考

针对当前医疗卫生行业存在的“政府不满意、老百姓不满意、医院不满意”的状况，重点分析了当前二级医院在现行医疗体制下，发展所面临的沉重压力及原因，对当前二级医院可持续性发展进行了思考，并提出了在政府投入、医疗资源配置、医疗保障制度、医院内部管理方面的对策和措施。     

对农村卫生投入情况的调查

卫生财力资源是发展农村卫生事业的重要保证，但是，改革开放以来，特别是在市场经济条件下，由于“财政分级包干”、各地经济发展不平衡和当地政府对农村卫生事业重视程度不同等原因，导致财政对农村卫生投入地区差距拉大．占财政支出的比例相对下降，使农村卫生事业的发展弱化．与广大农村居民的医疗卫生需求越来越不适应。为此，应努力开发农村卫生财力资源，以促进发展农村卫生事业。     

农村卫生政策的实践与探讨

农村卫生政策的实践与探讨湖北省卫生厅办公室一、当前农村卫生工作难点与对策当前在农村卫生事业发展与改革道路上存在的一些不容忽视的困难与问题，主要有：卫生投入严重不足，医疗卫生服务补偿机制不完善；资源配置和事业发展不平衡，卫生技术人员素质不高；相当一部分...     

优先发展基本卫生服务

中国卫生事业的发展存在着两种思路。第一种认为中国卫生资源总体不足，卫生发展落后于经济发展，建议继续做大做强卫生资源，对外可以增强医药产业的竞争力，对内可以满足广大人民群众日益增长的、不同层次的医疗需求。第二种思路承认相对于经济发展水平，中国卫生资源总量已经不低了，但是认为还存在着公共投入不足和低端服务机构发展滞后等结构性问题，建议增加公共投入，做小做适卫生资源（包括发展城市基层、农村卫生事业，建立济困医院或济困病房，控制大型医疗机构和大型设备，采用适宜技术等等）。     

以“五制”改革为重点 加快卫生事业发展步伐

以“五制”改革为重点加快卫生事业发展步伐吴金娃（山东省滨州地区行署副专员）滨州地区位于鲁西北平原，属经济欠发达地区。长期以来，由于历史和经济原因，我区卫生事业的发展明显落后，特别是投入不足，机制不活，管理不容，人才匮乏，技术落后，严重削弱了卫生事业的...     

潍坊市建立社区就医制度的探讨

一、社区卫生服务发展的主要问题前期的社区卫生服务机构改革未涉及体制和运行机制的改革，导致社区卫生服务发展中存在一些问题，如补偿机制不到位、卫生资源配置失当、社区卫生服务价格体系不规范等。由于政府投入与补偿政策的乏力，如果没有市场化运作的有偿服务，社区卫生服务机构将无法生存和发展，     

统筹城乡疾控体系公平发展的探索

目的：探索如何科学统筹、公平发展城乡疾控体系的办法和途径。方法：分析当前疾控系统中的城乡差距及影响因素，提出统筹城乡资源，改革投入体制，促进城乡公平发展的思路。结果：地域资源与投入体制是影响城乡差距的主要因素，统筹城乡资源，改革投入体制是促进城乡公平发展的办法和途径。结论：人员工资由地方财政投入，基础建设和业务公用经费由上至下分级投入，创收经费由下至上缴国库统筹是解决当前疾控系统城乡差距走公平发展道路的主要手段和途径。     

公立医院的公益性解析

公立医院应该追求“公益”是各界的共识，但“公益”的内涵尚不明确，对“公益”的理解过于宽泛，难以为公立医院改革提供理论政策上的指导。本文从公共财政学的角度阐述在市场经济条件下，公立医院要追求的“公益”是与私人利益相区分的公共利益，以及这种公共利益与医院本身经济效益之间的关系，从而为公立医院改革定位。     

Communitarian societies and public engagement in public health

For effective public health interventions in communitarian societies, public engagement must reflect cultural values that focus on preserving collectives, rather than individuals. The case of the Ebola epidemic in West Africa is used to reflect on the drivers and consequences of failure to incorporate local knowledge, local leaders and local ethical values in the adaption of programmes from elsewhere.     

公立医院公益性问题的博弈模型分析

在明确了政府、医疗机构、患者三者关系的基础上,建立了博弈模型,从而对非对称信息下公立医院的公益性弱化问题进行分析,并提出公立医院回归公益性的政策建议。     

Privatization of public services: organizational reform efforts in public education and public health

The public health and the public education systems in the United States have encountered problems in quality of service, accountability, and availability of resources. Both systems are under pressure to adopt the general organizational reform of privatization. The debate over privatization in public education is contentious, but in public health, the shift of functions from the public to the private sector has been accepted with limited deliberation. We assess the benefits and concerns of privatization and suggest that shifting public health functions to the private sector raises questions about the values and mission of public health. Public health officials need to be more engaged in a public debate over the desirability of privatization as the future of public health.     

The public and public health organizations: issues for community engagement in public health

Deliberative processes are beginning to take effect in the public health sector. Public health organizations have a critical role in fostering local deliberation during the planning and implementation of community health efforts. The chief executive officer (CEO) of eight national public health constituent organizations were provided background readings about deliberation and its potential role in community public health planning. They were then interviewed about their prior knowledge of public health deliberation, impressions and thoughts about deliberation's role in public health, whether they could identify constituents using the approach, and the best method of disseminating information on deliberation. Information provided by stakeholders was analyzed to gauge the understanding and implementation of public deliberation. Four main themes emerged from the interviews including: general awareness and attitudes about public deliberation, barriers to deliberation, words of caution when using the deliberative approach, and dissemination of deliberation. Each of the CEOs interviewed favored deliberative approaches in public health planning that would ensure that the community's voice is present in the decision-making process. However, there are certain limitations to the approach that must be addressed before the full benefits of public engagement can be obtained in public health.     

Teaching evidence-based public health to public health practitioners

PURPOSE: The purpose of the Evidence Based Public Health (EBPH) course is to train public health practitioners to utilize a comprehensive approach for program development and evaluation from a scientific perspective, including principles of scientific reasoning and systematic uses of data and information systems. The increasing technical sophistication of public health problems and approaches emphasizes the importance for an evidence-based approach to developing policy and interventions. METHODS: The training methods used highlight the linkages between data systems and program/policy initiatives. Participants learn to access and interpret existing data systems and methods of using data to impact specific policies or decision-makers. From 1992 through mid-2004 the EBPH course was offered a total of 20 times, in Missouri, nationally and internationally. In March 2002, the workshop was taped and pressed into a 16-CD set that public health workers can use as a self-teaching program in their own homes and offices. The group exercises from the classroom workshop have been adapted into individual self-guided applications, and background readings are included in the set. RESULTS: Compiled results of course evaluations indicate average ratings for course satisfaction ranging from 8.50 to 10.00 on a scale from 1 to 10. Satisfaction with course instructors ranged between 8.00 and 10.00 on the same scale. Ninety-four to ninety-six per cent of participants reported that they would use the course in their day-to-day work. Qualitative comments from participants at the time of and after the course show that the material is applied in a variety of ways. CONCLUSIONS: The EBPH course is making a valuable contribution in strengthening the application of scientific methods to public health practice. To expand the offerings of this training, a train-the-trainer component for the EBPH course is being developed, to be made available in 2005.     

试论公立医疗机构的公益性

目前，政府主导、坚持公立医疗机构的公益性已成为大家的共识，但是对政府主导什么、公立医疗机构的公益性如何体现争论较多。概括起来主要有两种观点，一是政府要在医疗卫生领域加大投入，抑制公立医疗机构营利动机，同时引入市场机制，加强成本核算，建立和完善对医务人员的激励机制，提高公立医疗机构的运营效率；二是政府应该主导医疗服务产品的提供而不是生产，医疗服务的公益性与医疗机构的公益性是两个不同的概念，换句话说，政府举办医疗机构如果缺失相应制度，并不能保证医疗服务和公立医疗机构的公益性。     

论如何做好卫生领域突发公共事件的风险沟通工作

近年来,随着社会经济的发展,卫生领域突发公共事件时有发生。卫生领域突发公共事件是指突然发生,造成或者可能造成严重社会危害,需要采取应急新闻处置措施予以应对的公共卫生事件和其他与卫生工作有关的公共事件、舆情事件等。本文总结了近年来卫生部门突发公共事件风险沟通工作情况,分析风险沟通工作的成效及存在的问题,并从日常工作、突发公共卫生事件、舆情事件三个层面提出做好突发公共事件风险沟通工作的措施建议,以期更好地防止突发公共事件的发生或降低甚至消除事件的负面影响,同时提升卫生部门的公信力,塑造卫生行业良好的声誉和形象。