上海市公共卫生体系建设发展现状与展望

2003年非典疫情后,公共卫生受到政府和公众前所未有的关注和重视.上海市先后实施完成了第一轮和第二轮的"加强公共卫生体系建设三年行动计划",并将启动实施第三轮行动计划,通过实施前两轮行动计划,上海市公共卫生体系框架逐步得到完善,城市公共卫生安全日益得到保障,市民主要健康状况和指标也不断得到改善和提高.本文在分析公共卫生概念和公共卫生体系范畴的基础上,回顾了上海近10年来公共卫生体系发展状况,并结合上海这个国际化特大型城市的特点,分析未来上海公共卫生体系可能面临的问题和挑战,提出体系发展方向和策略.

Abstract：

The government and general public has paid unprecedented attention to the public health after the outbreak of SARS in 2003. Based on the first and the second round of Three-year Action Plan for Public Health System Construction, the public health system in Shanghai has been gradually improved. The city's public health security has been increasingly consolidated and people's main health status and indicators have been constantly improved. Nowadays, the third round of Three-year Action Plan will be started. This paper will review the development of public health system in Shanghai in recent ten years, analyze the possible problems and challenges in the future and put forward the development direction and strategy of the system.     

医疗保险总额预付制对医院的影响及对策

分析了上海市医疗保险局自2009年在三级医院开始"医疗保险总额预付制"试点工作以来,总额预付制对医院的影响,提出了医院应及时转变观念,从提高医疗质量、加强成本核算、实现医疗保险管理信息化及精细化等方面着手,科学合理地控制费用,主动适应和推进医疗改革的进程.

Abstract：

The paper analyzed the impact of the trial for "lump-sum prepayment practice of medical insurance" on tertiary hospitals in Shanghai initiated by Shanghai Medical Insurance Bureau since 2009. Based on the analysis, the authors recommended that the hospitals should adapt to the changes by raising quality of care, improving cost accounting, informationizing and refining medical insurance information management, as well as controlling expenses on a rational basis. These approaches will help them adapt to and promote the ongoing health reform in China.     

流动人口基本公共卫生服务均等化调查

目的 了解流动人口与当地常住人口基本公共卫生服务不均等的情况.方法 通过现场调研和访谈,抽样调查了浙江省某县的流动人口和常住人口各581人,了解两种人群的基本公共卫生服务在投入、机会.结果 上的不均等情况.结果 流动人口中享受过医疗救助的比例仅占7.8%,低于常住人口的13.4%;有40.9%的流动人口会因为较高的医药费用而不去就医,远远高于常住人口;流动人口妇科检查率为58.7%,低于常住人口(67.7%).结论 应增加公共卫生机构资源配置和财政投入,发展和完善社会医疗保障体系,促进不同人群间基本公共卫生服务的均等化.

Abstract：

Objective To probe into the inequality found in primary public health service available to the migrant population and permanent residents. Methods With on-site interviews, 581 migrant workers and 581 permanent residents in a county in Zhejiang province were surveyed, to learn the inequalities between the two in the expenditure, access and outcomes of the public health service accessible to each. Results only 7. 8% of the migrant population ever had access to medical aid, a ratio far below that of the permanent residents; 40. 9% of the migrant population may turn down medical service beyond their affordability, a ratio far higher; for the migrant population, their ratio of gynecological checkup is 58. 7%, lower than that of the permanent residents (67. 7%). Conclusion Resources and financial allocation to institutions of public health should be enhanced, and social medical and insurance system should be developed and improved, in an effort to encourage the equality of primary public health services accessible to various sectors of the population.     

改革开放三十年上海市卫生事业总体进展和面临的挑战

以党的十一届三中全会召开为标志,上海卫生事业与其他行业一样,开始踏上改革开放的征程.本文回顾了改革开放三十多年来,上海卫生事业经历的各个发展阶段、所取得的成就以及目前面临的挑战.在此基础上,总结了上海卫生事业改革发展的基本经验.

Abstract：

Marked by the Third Plenary Session of the Eleventh Central Committee of the CPC, Shanghai health care started a journey of reform and opening up as with other sectors. This essay reviews various stages Shanghai health care experienced and the achievements for the last 30 years since reform and opening up, and analyzes the challenges Shanghai health care faces currently. On this basis, the essay summaries the experiences and lessons learned from Shanghai health care reform and development.     

上海市深化医药卫生体制改革的基本框架和总体思路

依据国家医改总体要求,结合上海实际情况,按照长远目标、目标、策略、措施、支撑和基础5个层次构建了上海深化医药卫生体制改革的基本框架;从建立覆盖城乡居民的基本医疗卫生制度、夯实医药卫生事业可持续发展的基础两个方面,总结了上海医改的总体思路.

Abstract：

Under the general requirements of China's national health reform, the basic framework of Shanghai's health reform was constructed at five different aspects the long term vision, goal, strategies, measures, supportive reform activities. The general thought of Shanghai's health reform can be concluded into two aspects: first, establishing a basic healthcare system of covering both urban and rural residents universally; second, enhancing the foundation of enabling sustainable health development.     

Utilization of traditional Chinese medicine services and its influencing factors among home‑based elderly care population in Zhejiang ProvinceCSCD

Objective To analyze the utilization of traditional Chinese medicine (TCM) services and its influencing factors among home‑based elderly care population in Zhejiang Province. Methods A multi‑stage stratified cluster random sampling method was used to enroll 2 300 home‑based elderly care population aged 65 years and over and lived in the local area for 6 months and above in Zhejiang Province. The basic characteristics, health status and behavior, TCM cultural literacy, TCM cognitive beliefs and TCM service usage of the subjects were collected by face‑to‑face questionnaires from July 15 to August 15, 2021, and 2 123 valid questionnaires were recovered. Unconditional logistic regression was applied to analyze the influencing factors of TCM service usage among home‑based elderly care population. Results The overall utilization rate of TCM services among home‑based elderly care population in Zhejiang Province was 36.46% (774/ 2 123). The utilization rates of the 6 types of TCM from high to low was oral administration of traditional Chinese medicine (22.00%), external treatment with traditional Chinese medicine (15.12%), acupuncture treatment (11.96%), medicated diet conditioning (7.44%), constitution identification (7.40%) and exercise conditioning (4.57%). Home‑based elderly care population lived in urban areas, had never been to school, with education of primary school or high school and above, suffered from chronic diseases, moderate activities or physical exercise, believed in TCM and had attended lectures on TCM knowledge were more inclined to use TCM services (all P<0.05); agricultural laborers, production and transportation workers and family laborers before retirement were less inclined to use TCM services (all P<0.05); women, those with medical insurance, those drinking alcohol and those with better TCM cultural literacy were more inclined to use 2 and more kinds of TCM services (all P<0.05). Conclusions The utilization rate of TCM services among home‑based elderly care population in Zhejiang Province is relatively high; gender, place of residence, education level, occupation before retirement, medical insurance, belief in TCM, and participation in TCM knowledge lectures are the main influencing factors of the use of TCM services among home‑based elderly care population. © 2021 Journal of Clinical Otorhinolaryngology Head and Neck Surgery. All rights reserved.     

上海市基本药物制度实施的主要思考与举措

回顾了国家基本药物制度相关政策,介绍了上海市基本药物制度实施的主要思考和举措,提出了改善上海市基本药物制度实施的建议,为上海及全国推进基本药物制度的建立、完善实施方案,提供了决策信息和可借鉴的经验.

Abstract：

The relevant policies of national essential medicine system were reviewed, major concerns and actions in the implementation of essential medicine system in Shanghai were introduced, and the suggestions to improve the implementation of essential medicine system of Shanghai were made. These provided the information for policy making and provided a useful experience for facilitating the establishment of essential medicine system and the improvement of its implementation in Shanghai as well as China.     

国外灾后医疗救助体制的特点与启示

分析了英、美、日等国灾后医疗救助体制的特点,结合我国现阶段的国情,提出政府应制定和完善灾后医疗救助法律体系、完善医疗保障相关制度、建立应对灾后医疗救助问题的长效管理机制、建立和完善灾后紧急预防和心理干预机制等建议.

Abstract：

This paper analyzed the characteristics of post-disaster medical assistance systems in Anglo-American countries and Japan. In consideration of China's national conditions at present, it come up with recommendations that the government should formulate and perfect the legal system of postdisaster medical assistance, improve the related systems of medical care, establish post-disaster medical assistance responding as a long-term management mechanism, establish and improve emergency preparedness, and post-disaster psychological intervention in mechanisms.     

上海市医疗机构设置规划研究

在分析上海市医疗资源配置、需求与利用现状的基础上,结合未来发展需求,探讨了上海市"十二五"期间医疗资源配置的总体目标、原则、规划重点及各级卫生行政部门的主导作用.

Abstract：

Based on the current status of allocation, demands and utilization of medical care resources and the needs for future development in Shanghai, the overall objectives, principles, key plans of allocation of medical care resources in the 12th Five-years Plan in Shanghai and the leading role of health bureaus at all levels were discussed.     

健康中国背景下医疗保障制度向健康保障制度转型探索

健康中国的国家战略明确要建立健康保障制度,从健康危险因素控制与保健因素促进入手保障居民健康。健康保障制度与医疗保障制度在保障目标、切入点、保障内容与补偿机制均存在差异,需要通过扩展保障的内容、医疗保险转向以健康为中心、医防教养融合等多种策略实现医疗保障制度向健康保障转型。以健康为中心的医疗保险改革需要从扩展健康内涵、支付方式改革入手,强化医疗保险对服务供给体系的约束与引导,同时这也是医疗保险发展的必然方向。     

大学生医疗保障问题的探讨

随着我国医疗保健制度的改革，大学生原有的保健体制将受到冲击。通过对2200例大学生的现场调查，从医疗满意度和参加医疗保险情况两个方面来探讨大学生医疗保障问题。结果表明：大学生对卫生服务态度期望值较高，医疗满意度远远低于全国总体水平，不满意的人数占70．5％，远远高于全国总体水平3．8％。大学生参加医疗保险人数占总调查人数的66．0％，参保意识不强，参加医疗保险是有效的医疗保障方式。建议将大学生的医疗保障制度纳入国家社会保障计划，增强大学生的保险意识，尤其应注意在提高医疗满意度上下功夫。     

城镇弱势群体面临的医疗保障问题与对策探讨

解决城镇弱势群体医疗保障问题,其切入口应放在职工基本医疗保险制度与医药卫生体制改革的大背景下,以基本医疗保险作为主体框架,在此基础上,进一步扩大医保覆盖面,提高保障力度,建立和完善城镇弱势人群的医疗救助制度和重点疾病的干预机制。     

论我国医疗保障制度改革的评价研究

我国已在全国范围内逐步完善城镇职工基本医疗保险制度 ,这一制度的改革不仅关系到我国城镇职工的健康需要 ,而且直接影响今后全国范围内医疗保险的实施。它是建立我国新的社会保障体系的三项重点之一 ,因而必须对其进行合理的评价。文章对我国医疗保障制度改革的实施评价的意义、必要性等进行了论述 ,指出评价的基本思路、评价指标、评价方法以及应用途径。     

国际经验对上海医疗体系改革的借鉴与启示

该文介绍了典型的4个国家和地区的医疗体系、卫生筹资和改革过程，借鉴其经验与教训，阐述了其对上海医疗体系改革的启示。     

An introduction to China's health care system

The Chinese health care system was originally a highly centralized one. It had great success in improving the people's health. The county-township-village three-tier health care system has contributed much to rural primary health care, and has set an example of primary health care to the developing nations. In the 1980s, this system experienced transformations along with the changes of the country's administrative system and economic policy. The transformations are characterized by the disintegration of the rural cooperative medical service, by the decentralization of township hospitals from county to township governments, by official permission for private practice, by the implementation of the personal responsibility system in health institutions, by the health security reform, and by the development of health insurance in rural areas. The long-existing health administrative problems which were aggravated in the last decade are the rural-urban differences in resource allocation and the large proportion of people without health security. With the increase of medical service prices in recent years due to the inflation of the whole economy, it is believed that the cost of health care will create an economic burden to the low-income, fee-for-service paying individuals and will further affect the health of the population. In the process of the national economic reform, it is an important and difficult task for the health administrators to adjust the health care system promptly and properly. Only by continuously carrying forward good traditions, correcting mistakes and consistently persisting in health reform, can China further raise its health care to a new, prosperous stage.     

多元化医保支付方式对医院管理能力的影响

随着国家医疗卫生的改革的不断深入,社会医疗保障体系逐步完善,全民医保网络初步形成,也实现了医保支付方式多元化发展。医保制度改革的目的就是促进社会保障体系正常运行,以进一步控制医疗费用的增长幅度,解决人们"看病难""看病贵"的问题。医保支付制度的改革使按服务项目收费、按服务单元收费、按病种付费、按人头付费以及按预算总额付费等多元化医保支付方式与现行医保制度相适应,逐步增强医务人员的管理责任意识,合理调整医院各科室组成部分,进而有效提升公立医院的服务质量及整体管理水平,促使医院发展更规范、更理性。     

政府协同与医保助推:“四医联动”保障下的家庭医生服务

政府协同式治理是当前我国医改推进的必要支撑和重要方向。上海市长宁区家庭医生制度模式发展过程中,通过卫生、医保、民政、财政等部门面向困难人群的"基本医疗保险+基本医疗服务+政府医疗救助+社会组织医疗帮扶"的"四医联动"基本医疗保障协同治理模式实现了激励相容的可持续发展。十年的改革探索和政策实践表明,卫计委、民政部门精准确定服务人群,医保、财政支付家庭医生签约服务费的政策协同,社区家庭医生工作室的医疗资源整合支撑,社区健康共建共享是我国家庭医生服务模式不断完善的发展方向。     

流动人口医疗保障问题研究——以衡阳市为例

近年来流动人口医疗保障问题，备受政府和社会的日益关注，学界也从各方面对流动人口的医疗保障问题进行了研究。文章对衡阳市流动人口医疗保障问题进行了调查研究，根据衡阳市流动人口的健康状况和医疗保障现状，提出“协同互补型”的流动人口医疗保障体系构建对策。     

2009年中国医疗保障研究综述

2009年以来,我国医疗保障制度建设步伐明显加快,统筹城乡发展,实现全民医保,成为医疗保障政策研究的热点。同时,理论界也开始更多地关注城乡医疗保障的公平性、科学性以及有效性等制度发展的深层次问题。本文从医疗卫生改革与医疗保障、城镇医疗保障、农村医疗保障、城乡医疗救助四个方面综述了2009年以来的相关研究,并地进行了简要评价。