全民健康覆盖的内涵及我国推进全民健康覆盖的策略选择

世界卫生组织提出全民健康覆盖的内涵在于全社会每个人公平的享有其应享有的服务,重点关注的是服务的利用及风险保护。"全民医保"不是全民健康覆盖,我国当前全民覆盖的医疗保障体系只是实现全民健康覆盖的制度工具,以促进居民卫生服务的利用,不能保障每一位居民都能利用到其应享有的服务,解决居民服务利用的公平性问题。全民健康覆盖中的健康服务还包括公共卫生服务、健康促进等。我国全民健康覆盖的发展应依托现有的基本医疗保障体系,在促进服务利用的同时关注弱势群体的服务利用,正确评估改革,重点关注服务利用的困难群体。     

全民健康覆盖实现程度的国际比较

目的 :基于筹资公平性、受益公平性、卫生服务可及性、卫生系统效率、国民健康素质5个关键评价维度,对典型国家的全民健康覆盖实现程度进行评价分析。方法 :采用灰色关联分析法对各国全民健康覆盖的实现程度进行了综合评价,了解影响我国全民健康覆盖目标实现的关键问题和制约因素。结果 :各国全民健康覆盖实现程度的排序由高到低依次为英国、德国、古巴、新加坡、泰国和中国,卫生服务筹资公平性和受益公平性成为制约中国全民健康覆盖目标实现的关键瓶颈。结论 :虽然医改的实施提高了我国医疗服务的可及性及卫生系统的服务效率,但综合评价结果显示,我国距离国际上全民健康覆盖实践最佳的国家仍有差距,需要从立法、监管体制和制度整合上多方探索。     

全民健康覆盖视角下的发展中国家卫生筹资机制比较

本文以墨西哥、泰国、中国为例进行卫生筹资机制的比较研究,考量不同卫生筹资机制对实现全民健康覆盖的影响。结果表明,多数中低收入国家致力于建立更加公平有效的筹资体系,加快医疗保障制度改革,依托多种医疗保障制度,推进全民健康覆盖。每个国家应根据自身经济情况开展全民健康覆盖;增加卫生筹资和提高资源使用效率是实现全民健康覆盖最重要的条件;对于由多种保障制度覆盖的国家中,应考虑全民健康覆盖的范围、保障内容、补偿水平以及所有制度基金的统筹水平。     

全民健康覆盖：需要研究证据支持的全球运动

"全民健康覆盖"是许多国家卫生体系发展和卫生政策所追寻的目标。目标的实现离不开具体政策和措施的推行,而在卫生政策的制定和评价中,科学研究的作用越来越受到重视。本文总结和分析了科学研究如何支持全民健康覆盖策略的制定和完善,以及研究如何评价全民健康策略对提高服务可及性、降低经济风险和健康促进的影响。在总结科学研究对全民健康覆盖的推动作用和存在问题的基础上,提出要更有效地推动我国"全民健康覆盖"的实现,研究机构和人员需要继续完善研究内容、提高研究质量、重视对现有高质量研究的利用、并推动研究结果向政策的转化。     

健康公平性概述

健康公平性在国际上得到广泛关注,各国把消除健康不公平作为卫生改革与发展的主要目标。本文就健康公平性的内涵进行梳理,为我国健康公平性内涵和测量研究提供参考。     

我国“全民医保”在“全民健康覆盖”进程中作用分析

目的:研究我国基本医疗制度全民覆盖在我国推进"全民健康覆盖"进程中的作用,同时剖析"全民健康覆盖"与"全民医保"之间的关系。方法:对比2003~2011年我国3次国家卫生服务调查中医疗保险覆盖率、住院补偿比、灾难性卫生支出等健康服务利用指标等相关数据。结果:我国实现了基本医疗保险全覆盖;医疗保险覆盖率和补偿比的双重提高促进居民更多地利用卫生服务;居民疾病经济负担并未明显减轻。结论:我国全民医保推动了全民健康覆盖的进程,但当前服务利用不公平性是全民健康服务推进的主要制约。     

卫生健康在共同富裕中的地位作用与主要任务

从共同富裕的内涵与基本任务出发,分析卫生健康与共同富裕的内在联系,阐述卫生健康在促进共同富裕中的地位作用与重点任务.实现更高水平的全民健康,既是共同富裕的必然结果和主要标志,也是实现共同富裕的基本前提和基础保障,二者辩证统一于中国特色社会主义发展的整个历史进程之中.共同富裕的五大具体目标与健康息息相关,为扎实推动共同富...     

广东省佛山市南海农村健康促进工作模式探讨

2008年,广东省佛山市南海区在实现了“村村卫生村”的目标后提出了“建设健康村工程”,以农村健康促进为抓手,通过开展构建健康管理网络、营造健康生活环境、保障公共卫生安全、健全卫生服务体系、完善健康保障体系、实施健康促进行动和普及健康锻炼活动等7项主要工作,用5年时间基本实现“村村健康村”目标,使村庄生态环境、社会环境和村民文明素质显著提高,健康公平性显著改进,主要健康指标达到全国先进水平。     

泰国全民健康覆盖经验及对我国的启示

本文介绍了泰国全民健康覆盖的经验及其对中国的启示。泰国于2001年通过"30泰铢计划"实现了全民健康覆盖。泰国全民健康覆盖显著的特点表现在三个方面,分别是区域医疗联合体为基础的服务提供体系,强调基层医疗卫生服务的核心作用,以及通过按人头支付等措施合理配置卫生资源。有研究证据表明泰国实施全民健康覆盖后,卫生系统绩效得到显著改善。我国在实现全民健康覆盖的过程中,可借鉴泰国经验,加强政府的政治承诺,强化基层卫生服务体系建设,开展协调的综合改革。     

健康公平严重缺失导致“看病贵、看病难”

解决"看病贵、看病难"首当其冲的是要找准形成"看病贵、看病难"的症结所在。除了从表面分析存在的医德、医技和医价的原因外,实质上老百姓"看病难"是难在健康权难以保障,"看病贵"是贵在公平性严重缺失。居民中各类健康不安全的人群、医疗卫生服务可及性、卫生服务需求和利用的城乡和地区差异、逐渐增加的个人负担医药费用比例和低收入人群承担了过重的经济负担等,反映了健康公平性严重缺失。     

Population health. More than the sum of the parts?

The past decade has seen an upsurge of interest in the development of summary measures of population health. Almost invariably the measures have relied on "rolling up" individual level health data such as mortality data or life expectancy data. The approach, however, of treating population health as a synthesis of aggregated individual level data is a historical and statistical convenience. Although there has been some debate in the literature about whether one should also examine the equity of the distribution of health, the general practice has been to treat the level of a population's health and the distribution of health within a population as separate issues. Without recourse to contentious notions of equity, this paper examines the possibility of treating populations as more than simply the sum of their parts by combining individual level health data with population level data about the distribution of health. This approach may provide policy makers with additional ways of thinking about what it means to improve a population's health.     

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。     

突发公共卫生事件对构建全民健康保障制度的启示

文章讨论了由突发公共卫生事件引发的对构建全民健康保障制度的反思及其政策措施。透过 SARS危机 ,暴露出我国现行医疗保障制度存在的诸多缺陷。提示我们应转变政府职能 ,加强法制建设 ,健全组织机构与管理制度 ,建立资金来源多渠道、保障方法多形式、保障水平多层次的全民健康保障制度。     

How should health and healthcare priorities be set and evaluated? Prioritization methods and regional disparities. 2008 SESPAS Report

The conflict between scarce resources and unlimited needs is perhaps more prominent in the healthcare sector than in any other areas. Thus, setting priorities in health care emerges as an unavoidable task. The laudable aim of adopting any health technology that improves the population's health is impossible when confronted by budgetary constraints. Therefore, the outstanding health problems of a society and the most efficient health technologies in terms of their cost-effectiveness must be identified and patients must be prioritized, bearing in mind aspects of equity and efficiency. The present article reviews the issue of setting health care priorities by examining the experiences that have been put into practice in Spain and abroad. The problem is analyzed at three levels: the "macro" level (strategic planning, identification of higher priority areas and the selection of health care interventions); the "meso" level (incorporation of cost-effectiveness analyses into clinical practice guidelines), and the "micro" level (how to design priority systems for patients on waiting lists based on clinical and social criteria). In all these levels, there is substantial heterogeneity between Spanish regional health services, the steps that need to be taken and the ground that needs to be covered. Thus, we suggest that the first steps that some regional health services have made, together with international initiatives, could serve as a reference for the definitive incorporation of new approaches in priority setting in the Spanish health system as a whole.     

新疆农村家庭2003～2008年卫生筹资公平性变化分析

[目的]研究2003～2008年新疆农村不同经济水平家庭卫生筹资的公平性变化。[方法]利用新疆2003、2008年国家卫生服务调查相关数据,运用比例法和指数法测算农村不同经济水平家庭各项卫生筹资渠道的公平性。[结果]2003、2008年税收支出的集中指数分别为0.33、0.36,Kakwani指数分别为-0.05、-0.02筹资趋向等比例;社会医疗保险支出集中指数分别为-0.33、0.15,Kakwani指数分别为-0.71、-0.23;商业健康保险支出集中指数分别为0.64、0.58,Kakwani指数分别为0.25、0.20;现金卫生支出集中指数分别为0.43、0.50,Kakwani指数分别为0.04、0.12。[结论]税收卫生筹资公平性变化不大,相对可支付能力而言筹资均趋向等比例,新农合改善了农村居民社会医疗保障筹资的绝对公平性,贫困家庭支付商业健康保险增多,现金卫生支出向富裕家庭倾斜程度加大。     

Provider performance in treating poor patients - <Emphasis Type="Italic">factors influencing prescribing practices in lao PDR: a cross-sectional study</Emphasis>

Background  

Out-of-pocket payments make up about 80% of medical care spending at hospitals in Laos, thereby putting poor households at risk of catastrophic health expenditure. Social security schemes in the form of community-based health insurance and health equity funds have been introduced in some parts of the country. Drug and Therapeutics Committees (DTCs) have been established to ensure rational use of drugs and improve quality of care. The objective was to assess the appropriateness and expenditure for treatment for poor patients by health care providers at hospitals in three selected provinces of Laos and to explore associated factors.     

卫生服务公平的逻辑分析与政策选择

卫生服务公平的内涵是指在同等健康与疾病状况下接受卫生服务的权利公平,并且基本卫生服务需要应该完全平等.卫生服务公平原则的实现需要有相应的社会经济条件作为基础,在当前情况下只能通过建立医疗保障制度,提高卫生服务可得性和可及性,以及补贴基本卫生服务等措施,达到基本卫生需要完全均等的标准.     

我国全民医疗保障制度建立的依据与目标

在研究分析社会保障制度和医疗保障的发展与变迁及其特征的基础上，提出我国全民医疗保障制度不同的发展阶段目标，第一阶段为保障基本卫生保健的公平可及性；第二阶段为逐步向筹资公平性目标迈进；第三阶段为促进健康公平性目标的实现。对全民医疗保障制度的内涵与外延、全民医疗保障制度设计基本依据与原则进行了阐述。     

The concepts and principles of equity and health

All the 32 member states in the World Health Organization EuropeanRegion adopted a common health policy in 1980), followed byunanimous agreement on 38 regional targets in 1984. The firstof these targets is concerned with equity. Target 1: "By the year 2000, the actual differences in healthstatus between countries and between groups within countriesshould be reduced by at least 25%, by improving the level ofhealth of disadvantaged nations and groups" (WHO, 1985a). In addition, equity is an underlying concept in many of theother targets. At present, the targets are being reassessedand revised, in particular moving away from a focus on physicalhealth status as measured by mortality to encompass, whereverpossible, many other dimensions of health and well-being. Butstill the underlying concept of equity in health has been judgedto be just as important for the 1990s as it was when the programmebegan (WHO, 1985b). However, it has not always been clear what is meant by equityand health and this paper sets out to clarify the concepts andprinciples. This is not meant to be a technical document, butone aimed at raising awareness and stimulating debate in a widegeneral audience, including all those whose policies have aninfluence on health, both within and outside the health sector.     

对贫困人口实施医疗救助

本文在分析了我国城乡居民收入分配中的公平性加重、医疗保障水平降低、医疗费用大幅度上涨、个人负担比例增加和卫生保健等筹资的“供方投入”模式的不合理性以及贫困人口较差的健康状况和卫生服务利用水平、贫困人口的主要健康问题、“需方投入”模式对供方的激励作用的基础上,认为对贫困人口实施医疗救助不仅符合公平原则,而且符合效率原则。医疗救助计划应该成为我国目前正在步步深入的卫生改革的重要组成部分。作者分别以我国