国际全科医生制度发展历程:影响因素分析及政策启示

全科医生制度建设的国际经验可以为中国全科医生制度的建立和发展提供借鉴。本文首先梳理了国民健康服务体制、社会医疗保险体制、商业医疗保险体制等部分典型国家的全科医生制度发展历程,重点分析了全科医生制度建设的影响因素。结果发现,建立和发展全科医生制度的主要影响因素有:经济社会因素、卫生保健体制对卫生体系的控制力、医师对卫生体系的控制力、全科医学服务的激励机制、全科医学的发展程度等。最后,结合近年我国全科医生制度建设的实际提出几点政策启示,一要以满足我国公众健康需求为目标,构建中国特色全科医生制度;二要普及全科医学服务核心价值,为建立全科医生制度提供公众民意基础;三要建立健全促进全科医生制度发展的激励机制,提高全科医生地位;四要积极推动全科与专科医学的专业分工,促进全科医学发展。     

为患者而工作——英国卫生服务体制改革简介

英国卫生服务体制建立于1948年,属于典型的福利型卫生服务制度。它为所有人提供的综合性卫生服务,不管其收入如何,整个卫生服务体制的费用主要由国家税收支付。多年来,英国卫生服务体制为国民提供了高质量的卫生服务,医疗技术水平保持世界一流。但随着社会的发展,特别是80年代     

浅谈卫生统计与信息化工作在基层医改监测评估中的作用

在国家新医改政策的指引下,2009年以来,基层医疗卫生机构加快卫生信息化建设步伐,坚持卫生统计与信息化服务医改、服务基层、服务群众的原则,紧密围绕医药卫生体制改革,以大力推进卫生信息化建设、加强医改监测与评估为重点,充分利用现有卫生信息化资源,在农村卫生服务体系建设、医疗保障、基本药物制度的建立、基本公共卫生服务、社区卫生服务等方面做了大量的工作。有效推进了基层医药卫生体制综合改革。     

瑞典开展协同卫生服务的经验及启示

为应对老龄化及卫生服务体系“碎片化”等挑战,瑞典通过体制机制建设,以卫生服务链的形式开展卫生服务体系内部的纵向整合;通过建立全科服务团队的横向整合来促进卫生服务的协同性;通过完善相关法律法规,加强卫生体系与非卫生体系的合作。针对中国卫生服务体系存在的碎片化问题,基于瑞典开展协同服务的做法和经验,从法律法规、卫生信息系统建设、基层人才建设、分级诊疗体制机制、全科服务团队建设以及卫生体系内外协同等提出相关政策建议。     

中国和泰国卫生体制现状比较分析

从中国和泰国的卫生经费筹集与使用、卫生资源状况、卫生服务提供、新型医疗保障制度等方面对两国的卫生体制进行对比,分析两国卫生体制存在的特点及其差异。分析了泰国卫生体制的优势,为我国卫生体制改革的具体实施提供参考。     

卫生服务与医疗保障管理体制的国际趋势及启示

本文在分析医疗卫生服务、医保基金、参保人群三方相互关系基础上,论述了理顺医保基金与卫生服务两大体系之间相互关系的必要性和重要性。文章根据国际上卫生服务与医疗保障管理体制的发展变革趋势,提出应该重视"一手托两家"的体制建设,促使卫生服务体系与医疗保障制度更好地满足患者的需要和时代的要求。     

中国和泰国卫生体制现状比较分析

从中国和泰国的卫生经费筹集与使用、卫生资源状况、卫生服务提供、新型医疗保障制度等方面对两国的卫生体制进行对比,分析两国卫生体制存在的特点及其差异。分析了泰国卫生体制的优势,为我国卫生体制改革的具体实施提供参考。     

构建与和谐社会相适应的卫生体制

卫生体制改革对建设和谐社会意义重大，能够促进社会公平，维持社会稳定；能够再生生产力，保护劳动力资源；能够缓和医患关系，体现人文关怀。但目前卫生体制改革面临着健康不公平、卫生服务不公平和公共卫生服务能力严重滞后的问题。本文期望通过发展基层卫生机构、健全医疗保障制度、重构公共卫生体系，改善卫生服务可及性公平、利用公平和筹资公平，以建立与和谐社会相适应的卫生体制。     

专科医师制度的建立顺应卫生体制改革和社会发展需求

专科医师制度的建立是我国进入WTO后卫生体制与世界接轨的举措,也是人民群众日益增 长的卫生服务需求。我国的住院医师规范化培训制度的实施已为专科医师制度的建立打下了良好的基础。 总结我院规范化培训的经验和成绩作为借鉴,以顺应卫生体制的改革。     

澳大利亚卫生政策分析对解决我国医疗机构改革具体问题的启示

目的研究澳大利亚卫生体制,探讨解决中国医疗机构改革的具体问题。方法分析澳大利亚国家卫生体制的主要特征、卫生费用的分配,对照我国卫生医疗机构的现状和面临的问题,探讨切实的解决方案。结果澳大利亚政府对卫生服务的投入远大于我国,医疗服务付费主要由国家负担,医疗机构分布相对合理,转诊转院制度比较完善。我国医疗机构投资不平衡,卫生资源配置不够合理.这些问题与我国政府卫生投入不足、卫生部门指导监督不利、医疗机构盲目追求经济利润有直接关系。结论发展策略:(1)卫生资金分配方面,重视用项目来管理、科学合理分配资金,发挥卫生"守门人"双向转诊制度对卫生资源合理配置的必要补充作用。(2)服务体制方面,多元化发展,完善的医疗保险制度,构成政府、社会和个人对健康责任的分担机制。     

An evaluation of occupational health services within the NHS in London

AIMS: To establish the nature, extent and organization of occupational health service provision for employees within the National Health Service (NHS) in London and to review the systems for monitoring performance. METHODS: Human resources directors and occupational health managers were contacted from a random selection of NHS trusts in the London area and invited to complete an interviewer-led questionnaire. RESULTS: All seventeen trusts interviewed claimed to provide an occupational health service to their employees, with 88% providing this service in-house. The organization of the services varied, although most resided within the human resources function. Only 29% of the trusts could provide a written occupational health policy. Teaching hospital trusts had the most qualified and the highest numbers of medical staff. District/General hospital trusts had the least qualified clinical staff. Although most trusts were able to provide a comprehensive range of services, 87% of occupational health managers felt they could only provide a reactive service. Income was generated from non-NHS sources by 88% of the trusts and all were aware of NHS Plus. There was an indication that some trusts assigned NHS Plus status did not meet the standard of NHS Plus, although the survey took place only 3 months after the launch of NHS Plus. CONCLUSIONS: There was a significant variation in the nature and extent of occupational health services in the NHS trusts. As a consequence, there may be differences in the level of occupational health service available to staff across the NHS in London.     

New labour and Britain's National Health Service: an overview of current reforms.

Britain's National Health Service (NHS) has been the subject of unprecedented market reforms, which have failed to solve its problems. The New Labour government elected in 1997 has halted the drive toward the marketization of health care and replaced cost with quality as the central concern of NHS administration and policy. Major changes are occurring in the regulation of professional activity, with profound implications for the medical profession and the health service. The authors discuss these changes and possible future problems for the NHS.     

医保基金战略购买:基本概念、国际经验与中国镜鉴

中国特色医保基金战略购买是一个在"前瞻、系统、整体"战略视角指导下,以医保基金为购买主体,医疗服务为购买客体,追求医疗服务体系结构优化、国民健康收益结构优化的动态、循证、优化过程.战略购买在欧洲地区的实践效果不佳,本文以NHS英格兰为例对其政策实践和失败原因做了梳理总结,认为其主观上的改革理念彷徨、客观上的供需力量失衡...     

Service management: New Zealand's model of resource management

The health system in New Zealand, which in many respects is similar to that of the United Kingdom NHS, is currently undergoing massive change. In 1989 fourteen area health boards were formed, each board being accountable to the minister of health for achieving health goals and providing comprehensive health services for its defined population. This process has been assisted by the promulgation of a set of national health goals and a national health charter. Within area health boards the principle of general management is being implemented. Organisational structures are moving away from hospitals to services in a process which is being called service management which may be defined as the decentralisation of general management to the clinical workface. Similar in many respects to the resource management initiatives in the NHS it brings together medical, nursing and business management at the operational level with one person being accountable for the achievement of quality of care objectives within a budgetary framework. Budgetary restraints in excess of 10% have been achieved in the last 12 months partly through the service management process. Service management is seen to be a major paradigm shift in health services organisation and could be of international significance in its potential for achieving medical accountability for cost containment and quality assurance, and for coordinating care across agency and disciplinary boundaries.     

Developing health and social care under the reforms of Tony Blair and Clement Attlee, Prime Ministers of Great Britain and Northern Ireland

In July 1948, the British National Health Service (NHS) was introduced by then Prime Minister Clement Attlee with the aim of offering "free" medical treatment for the entire British population from cradle to grave. Since then, the British public have come to see the NHS and its free health care as a fundamental human right and a cornerstone to their democracy, and subsequent governments have been understandably reluctant to change or reform this popular program. Yet, funding issues, as well as societal changes and technological advances, are threatening the way the NHS performs. While the NHS was intended to be a flexible and responsive service, its restrictive practice culture and attitudes of staff, organizational flaws, and funding issues often work against patients' interests and government ideas of health policy. This paper outlines how the Blair Government has attempted to alter health and social care within the UK and to fundamentally change how the NHS works, with particular effect on its staff.     

Socialism and the British National Health Service

This paper examines some of the key characteristics of a socialist health care system using the example of the British National Health Service (NHS). It has been claimed that the NHS has socialist principles, and represents an island of socialism in a capitalist sea. However, using historical analysis, this paper argues that while the NHS claims some socialist ends, they could never be fully achieved because of the lack of socialist means. The socialist mechanisms which were associated with earlier plans for a national health service such as a salaried service, health centres, elected health authorities and divorcing private practice from the public service were discarded in negotiation. Moreover, even these would have achieved socialism merely in the sense of distributing health care, without any deeper transformation associated with doctor-patient relationships and prevention. In short, the NHS is more correctly seen as nationalised rather than socialised medicine, achieving the first three levels of a socialist health service identified here. It can be said to have socialist principles in the limited distributional sense and has some socialist means to achieve these. However, it lacks the stronger means to fully achieve its distributional goals, and is very distant from the third level of a radical transformation of health care.     

Provision and staffing of NHS occupational health services in England and Wales

OBJECTIVES: To establish the extent of Occupational Health (OH) service provision in the National Health Service (NHS). METHODS: Two postal questionnaires were used to obtain information from purchasers and providers in the NHS in England and Wales. RESULTS: 99.6% of trust and health authority employers claim to provide some form of OH service to their employees indicating widespread recognition of need, but virtually no service is provided to other staff such as general practitioners (GPs), general dental practitioners (GDPs), and their staff. There is a wide variability in the range and quality of OH services, suggested by the enormous differences in medical staffing levels, and the contractual restrictions where the OH service is provided by another NHS employer. Only about a third (highest estimate) to a quarter (lowest estimate) of NHS staff have access to a specialist occupational physician. CONCLUSIONS: Substantial inequality of access to OH services exists for the NHS workforce, despite previous guidance. There is no real evidence to suggest why the extent of provision of OH services varies so greatly between institutions.

 

     

A national public health service.

The development of the British public health services is briefly reviewed and it is suggested that two types of epidemiologist (Community Physician) are necessary in each locality: one concerned with medical administration and health care planning-the medical administrator, and the other with the prevention of disease-the clinical epidemiologist. A new nation public health service is proposed to revive disease prevention with four main features: (1) A district Clinical Epidemiologist who is a member of the district department of community medicine with responsibility for prevention but with no district administrative duties. (2) A District Epidemiology Unit comprising other appropriate staff. (3) National specialist epidemiology units within the NHS with service roles to support and coordinate the District Clinical Epidemiologists. (4) A national authority within the NHS with responsibility for prevention and for administering the national specialist units.     

The politics of modernization: Britain's National Health Service in the 1980s

The history of the British National Health Service (NHS) over the past decade demonstrates both institutional adaptation and insulation from more basic structural change. Reflecting international trends, the NHS has, on the one hand, recentralized decision making, adopted strong managerialist policies, accommodated a modicum of privatization, and stressed the client's role in some service choices. On the other hand, the government has skirted introducing unbridled competition into the health service. Assessment of a 1989 "Government Review" highlights the tensions the NHS faces between budgetary pressures and consumer demands, and between centralized controls and medical autonomy, among others.     

Equality, fraternity and liberty?

The provision of health care is as much a matter of social and political arrangements as of medical science, and thus varies greatly from country to country, reflecting the values of different societies. Janet Stevens looks at the values implicit in the French service, and contrasts them with those of the NHS.