社会资本举办中医医疗机构在发展中存在的准入问题研究

为了更好地倡导和鼓励社会资本举办中医医疗机构,分析和探索社会办中医发展中的准入设置问题,对基层社会资本举办的中医医疗机构进行实地调查,并结合当下我国医疗机构准入设置政策法规,总结出社会资本举办中医机构的卫生规划、用地及主体性质、诊疗科目设置、人员配备以及资本进入等准入设置问题,政府在进行推进社会办中医政策研究中应重视此类准入设置问题.     

重庆市南岸区社会办中医养生保健机构卫生学现况分析

目的掌握重庆市南岸区社会办中医养生保健机构的卫生状况,为提高卫生监督能力和督促养生保健行业正规发展提供决策依据。方法对重庆市南岸区69家社会办中医养生机构展开卫生学现况调查,并进行合格率和单样本均值分析。结果 2015年抽样的69家社会办中医养生机构检测大部分项目合格,空气、水检测指标情况良好,不合格项目主要集中在细菌指标,其中从业人员手上细菌菌落、面膜盆上细菌总数超标较多。结论中医养生保健机构消毒情况存在一定程度的卫生隐患,应通过加强卫生监督、引导单位自律等多种综合措施,以促进中医养生保健行业的健康快速发展。     

广西社会办中医医疗机构发展现状研究

[目的]分析广西区社会办中医医疗机构的发展现状,为促进广西区多元办医格局提供参考。[方法]基于广西区卫生统计年鉴数据,从公立和社会办中医医疗机构数、床位数、卫生人力等视角,采取定量分析,并将社会办中医医疗机构和公立中医医疗机构的发展情况进行对比。[结果]2009-2013年,社会办中医医疗机构数平均占比为13.76%,卫计人员平均增长率为7.74%,床位数平均增长率为9.30%。[结论]社会办中医医疗机构数量占比仍然偏小、卫技人员数逐年增长,但对比公立中医医疗机构差距很大,与公立中医医疗机构相比市场竞争力不足。应尽快落实鼓励社会办医政策,加强对社会办医疗机构的监管力度。     

社会办医的新时期：机遇、挑战与对策

国家对社会资本举办医疗机构的重视不断增强,社会办医的发展具备政策、经济和社会等方面的条件,社会办医发展不断加速.但加快发展社会办医仍然存在目标和定位不清、社会资本引入动力不足、可持续性发展困难、政府和市场角色混淆和监管不力等问题.本文在分析了社会办医发展现状的基础上明确了加快发展社会办医的机遇与挑战,并提出了应对挑战的对策建议,即拓宽社会办医的服务内容与人群、创造良好的资本进入环境、促进社会办医可持续性发展、明确政府和市场在社会办医中的职能和加强对社会办医的监管.     

社会化办医困境与对策分析

社会化办医在面对旧有困境的同时,也面临更大的发展机遇.对我国社会化办医的现状和困境进行综述,并在此基础上提出相关对策.社会化办医的主要困境包括:行业信任危机、缺乏合理发展战略、未充分发挥社会资本优势等.针对诸困境,发挥行业协会自律互促功能、发掘医疗产业融合发展增长点、探索政府统筹整合的顶层设计思路等将有利于社会化办医的良好发展.     

我国社会办医现状及对策分析

通过对我国社会办医政策进行梳理,并依据《2018中国卫生健康统计年鉴》的数据对社会办医政策落地实施效果进行分析,找出当前社会办医疗机构发展中存在的问题,为引导和促进社会办医持续健康规范发展提供参考建议。     

江苏省社会办中医近五年政策回顾与分析

为积极落实国家社会办医工作,江苏省出台一系列扶持政策,尤其鼓励社会办中医。本文回顾了江苏省2009-2015年社会办中医政策,结合主要城市社会办医落实情况,总结现行政策存在中医类医院扶持力度不足、乡镇中医发展滞后、中医类卫生人才匮乏等问题,并提出政策建议。     

浙江省社会办中医的政策回顾与分析

2009年国家启动新一轮深化医药卫生体制改革,提出大力鼓励和引导社会资本发展医疗卫生事业,浙江省贯彻落实国家政策的精神同时结合实际也出台了关于社会办医的一些政策。本文对浙江省在2009至2015年初出台的有关社会办医政策进行回顾,并对这些政策进行分析,特别是社会办中医的相关政策,提出政策建议,为浙江省社会办医健康发展提供理论依据。     

基于决策树和主动学习的护理院住院费用监管方法实证研究

随着我国医保覆盖面的扩大和保障水平的提高,违规骗保、过度诊疗、资源浪费等问题愈演愈烈.与此同时,根据国家进一步促进社会办医持续健康规范发展的要求,医保将面临越来越多的社会办医纳保的局面,更加大了医保基金的风险和监管压力.     

公私合作制度对我国发展社会办医的启示

新医改形势下,政府大力鼓励社会办医,其中公私合作制度(PPP)是解决公立医院融资困难,加快公立医院改革与建设的重要路径和尝试.结合PPP在国内外的成功经验,立足我国公立医院发展实际,探讨更好地让社会办医落地的政策建议:一是加强PPP模式的制度建设:将社会办医纳入医保,鼓励医师多点执业;二是完善社会办医补偿机制;三是将社会办医纳入医联体共建.     

Consumers' perceptions of health care: the case of Hong Kong

The health care industry in Hong Kong has undergone major changes in organization as well as philosophy of operation since the 1970s. During this period, the Hong Kong government has also experienced a political transition from colonial status to a special administrative region of Mainland China. Because of the economic downturn in East Asia, including Hong Kong, contraction of public spending has compelled the government to reconsider the alternatives for health care provision in Hong Kong. A number of multinational health care providers have entered this market and operate mainly in the private sector, including solely-owned clinics and alliances with existing hospitals. This paper provides an understanding of the evolution and development of the health care industry in Hong Kong and, on that basis, suggests elements of quality health care from the findings of a survey of patients.     

Referral to and attitude towards traditional Chinese medicine amongst western medical doctors in postcolonial Hong Kong

Recognizing the international trend for patients to choose both allopathic western medicine (WM) and traditional, complementary and alternative medicine (TCAM), the World Health Organization has called for stronger collaboration between WM doctors (WMD) and TCAM practitioners. This resonates with the situation in Hong Kong where the dominant modality of patient care is primarily based on WM practice while traditional Chinese medicine (TCM) is often used as a complement. The roots of this utilization pattern lie in colonial history when TCM was marginalised during the British administration. However since 1997 when China regained sovereignty, policies to regulate and professionalize TCM practices have been formally introduced. Despite both its popularity and this policy shift, progress on implementing collaboration between WM and TCM clinicians has been slow. This study, the first since 1997, explores current attitudes and referral behaviours of WMD towards use of TCM. We hypothesised that WMD would have positive attitudes towards TCM, due to regulation and cultural affinity, but that few actual TCM referrals would be made given the lack of a formal collaboration policy between elements within the healthcare system. Our results support these hypotheses, and this pattern possibly rooted from structural inhibitions originating from the historical dominance of WM and failure of services to respond to espoused policy. These have shaped Hong Kong's TCAM policy process to be closer with situations in the West, and have clearly differentiated it from integration experiences in other East Asian health systems where recent colonial history is absent. In addition, our results revealed that self use and formal education of TCM, rather than use of evidence in decision making, played a stronger role in determining referral. This implies that effective TCAM policies within WM dominated health systems like Hong Kong would require structural and educational solutions that foster both increased understanding and safe referrals.     

Factors associated with the use of publicly funded services by Hong Kong Chinese older adults

This article analyzes cross-sectional data collected from a representative community sample of 2003 Chinese elderly people aged 60 or above in Hong Kong. We examined whether the use of publicly funded health services by older adults is equitable under the framework of Andersen model. A number of predisposing, enabling, and need factors were assessed as predictors of utilization in four categories of services including hospital admission, emergency room, general outpatient clinics, and specialist outpatient clinics. It was found that utilization of these four health services was consistently correlated with need factors. Specifically, self-rated health status and particular types of chronic illness were consistently and significantly related to utilization for all four of services in Hong Kong. On the other hand, age and family support were related to hospital admission whereas functional impairment was associated with the use of emergency room and general outpatient clinics. Findings suggest that publicly funded health services in Hong Kong are used equitably by elderly people.     

Charcoal burning suicides in Hong Kong and urban Taiwan: an illustration of the impact of a novel suicide method on overall regional rates

OBJECTIVES: Following the first case in Hong Kong in 1998, the method of committing suicide by charcoal burning has spread to other communities. This aim of this study was to examine the impact of charcoal burning suicides on both overall suicide rates and older-method suicide rates in Hong Kong and urban Taiwan. DESIGN: Trend analysis of the overall and method-specific suicide rates between 1997 and 2002. Comparison of age and gender profiles of those who committed suicide by charcoal burning and other methods of suicide. SETTING: Hong Kong and Urban Taiwan. MAIN RESULTS: Suicides by charcoal burning increased rapidly within five years in both Hong Kong and urban Taiwan. This increase was not paralleled by decreases in suicides by older methods and led to an increase of more than 20% in the overall suicide rates. Those in the 24-39 age range were more likely to choose charcoal burning than other methods. CONCLUSIONS: The lack of parallel decreases in the suicides rates of older methods with the rise of charcoal burning suicides suggests limited substitution between the methods. The preponderance of the rise in suicide deaths associated with charcoal burning suggests that its invention, followed by wide media dissemination, may have specifically contributed to the increase in suicides in both regions. As a similar increase was found in urban Taiwan as in Hong Kong, charcoal burning suicide should not be viewed as merely a local health problem and has the potential to become a major public health threat in other countries.     

我国港澳地区医疗券制度及其对内地的启示

引入市场竞争机制是医疗体制改革的重点和难点。我国港澳地区的医疗券制度能够为内地推进医改体制创新、倒逼公立医院改革和合理配置医疗卫生资源提供借鉴。本文首先介绍了医疗券制度的起源和发展。然后详细阐述了港澳地区医疗券制度的实施背景、异同与政策效果,发现医疗券制度在引导需方更多使用私立医疗服务、提高居民预防保健意识、推广家庭医生制度等方面起到了积极作用。最后对医疗券制度在内地的适用性进行了分析,指出其与内地医改导向相契合,并可作为内地医保制度的有益补充和推动社会办医的有效措施,在完善内地医疗保险、医疗救助制度和发展私立医疗机构等方面具有一定的可行性。     

Age, chronic non-communicable disease and choice of traditional Chinese and western medicine outpatient services in a Chinese population

Background  

In 1997 Hong Kong reunified with China and the development of traditional Chinese medicine (TCM) started with this change in national identity. However, the two latest discussion papers on Hong Kong's healthcare reform have failed to mention the role of TCM in primary healthcare, despite TCM's public popularity and its potential in tackling the chronic non-communicable disease (NCD) challenge in the ageing population. This study aims to describe the interrelationship between age, non-communicable disease (NCD) status, and the choice of TCM and western medicine (WM) services in the Hong Kong population.     

Strengths and weaknesses of traditional Chinese medicine and Western medicine in the eyes of some Hong Kong Chinese

OBJECTIVE: To explore the attitudes of Hong Kong Chinese towards the strengths and weaknesses of traditional Chinese medicine (TCM) and Western medicine. DESIGN: Qualitative study of subjects' opinions using semi-structured focus group interviews. SETTING: Southern district of Hong Kong Island where many of the residents have a fisherman background. PARTICIPANTS: Twenty nine participants took part in eight focus group interviews. MEASUREMENTS AND MAIN RESULTS: Participants' attitudes towards TCM and Western medicine were explored in the interviews. Both TCM and Western medicine are used concurrently by many people in Hong Kong. Patients make decisions on which type of doctors they want to see for the specific illnesses that they are suffering from. They consider both types of medicines to have strengths and weaknesses: TCM being better in curing the root of the problem but quite slow in action while Western medicine is more powerful but sometimes too powerful with significant side effects. CONCLUSIONS: It is important for medical practitioners to be aware of the health attitudes of their patients from different ethnic backgrounds. It will lead to a better patient-doctor relationship and better compliance of treatment.     

Horizontal equity in health care utilization evidence from three high-income Asian economies

This paper compares the extent to which the principle of "equal treatment for equal need"(ETEN) is maintained in the health care delivery systems of Hong Kong, South Korea and Taiwan. Deviations in the degree to which health care is distributed according to need are measured by an index of horizontal inequity. Income-related inequality in utilization is split into four major sources: (i) direct effect of income; (ii) need indicators (self-assessed health status, activity limitation, and age and gender interaction terms); (iii) non-need variables (education, work status, private health insurance coverage, employer-provided medical benefits, Medicaid status (low-income medical assistance), geographic region and urban/rural residency and (iv) a residual term. Service types studied include western doctor, licensed traditional medicine practitioner (LTMP), dental and emergency room (ER) visits, as well as inpatient admissions. Violations of the ETEN principle are observed for physician and dental services in Hong Kong . There is pro-rich inequity in western doctor visits. Unusually, this inequity exists for general practitioner but not specialist care. In contrast, South Korea appears to have almost comprehensively maintained ETEN although the better-off have preferential access to higher levels of outpatient care. Taiwan shows intermediate results in that the rich are marginally more likely to use outpatient services, but quantities of western doctor and dental visits are evenly distributed while there is modest pro-rich bias in the number of LTMP episodes. ER visits and inpatient admissions in Taiwan are either proportional or slightly pro-poor. Future work should focus on the evaluation of policy interventions aimed at reducing the observed unequal distributions.     

Experimental infection of human volunteers with a swine influenzavirus antigenically related to the human A-Hong Kong-68 virus

An influenzavirus of swine origin (swine/Taiwan/7310/70) antigenically closely related to the human A/Hong Kong/68 virus readily infected human volunteers. Those infected developed antihaemagglutinin and antineuraminidase antibodies to the human A/Hong Kong/68 virus as well as to the swine/Taiwan virus. The clinical reactions produced by the swine/Taiwan virus were, however, milder than those produced in volunteers infected with A/Hong Kong/68. In contrast, two other “classical” swine viruses (strains antigenically related to the prototype swine/Iowa/15/30 strain), immunologically distinct from the Hong Kong/68 virus, possessed low infectivity for man.     

"Exposing the cracks": Severe Acute Respiratory Syndrome and the Hong Kong health system

PURPOSE: Hong Kong was particularly affected by the 2003 outbreak of Severe Acute Respiratory Syndrome (SARS). During the epidemic, it seemed as if the Hong Kong government and health system were barely coping, leading to calls of mismanagement and governance incapacity. In the wake of the SARS outbreak, two inquiries were conducted. The purpose of this article is to review the Hong Kong's response to SARS from the perspective of two inquiries. DESIGN/METHODOLOGY/APPROACH: An historical analysis of the institutional arrangements for health care delivery in Hong Kong is undertaken, followed by a chronology of developments in the SARS outbreak. The article then reviews outbreak management and the findings of the two inquiries. Finally, it considers whether the Hong Kong health system can be reformed to manage any future infectious disease epidemic better. FINDINGS: Both leadership and coherency were lacking in Hong Kong's response to SARS. These are age-old problems in the Hong Kong health sector. The prospects for mending the health system appear limited, given that leadership and coherency have been consistently absent features of post-1997 governance in Hong Kong. RESEARCH LIMITATIONS/IMPLICATIONS: This article reviews events in the immediate period following the SARS outbreak. A future follow-up study of the Hong Kong government and health system's capacity to respond to infectious disease outbreaks would be useful. PRACTICAL IMPLICATIONS: This article provides a review that will be useful to policymakers and researchers. ORIGINALITY/VALUE: No other article reviews the Hong Kong health system's SARS response.