理顺医疗管理模式 发挥宏观调控机能：关于医疗行业配套改革的思路？…

本文就医疗行业的配套改革探讨了总体思路１建立基本医疗保障与市场机制并存的管理体制；２完善基本保障和市场需求互补的供求模式；３实行基本医疗保障与市场需求的价格双轨制；４健全政策法规与舆论监督相结合的管理运行机制，。     

重庆对城乡医疗救助与基本医疗保险制度相衔接的探索

医疗救助制度与基本医疗保险制度相互配合,相互衔接,构成我国完整的基本医疗保障系统.目前全国各地积极开展医疗救助与基本医疗保险制度衔接的试点,重庆是先行者之一,其经验值得借鉴.文章主要总结重庆在实施医疗救助与基本医疗保险制度相衔接中的特点和取得的实效,并分析存在的问题,提出相关政策建议.     

医疗救助在医疗保障体系中的地位和作用

医疗救助是政府对因患病而无经济能力诊治的贫困人群,实施专项帮助和资金资助的一种医疗保障制度。从保障人群的健康权,促进社会稳定,构建和谐社会,提高医疗服务及医疗保险制度公平性的高度出发,论述了建立与发展医疗救助制度的重要意义;分析了我国实施医疗救助的特点以及医疗救助与基本医疗保险的共同点与区别;阐述了医疗救助在医疗保障体系中的地位和作用。     

医疗保障与医疗服务统筹管理：国际经验与中国现状

统筹管理医疗保障和医疗服务,符合医疗保障制度的发展要求和特殊性。医疗保障管理体制在平衡保障基金、医疗服务提供和医疗服务监管三个核心要素时,形成了分离模式、半统筹模式和全统筹模式三种模式。不同医疗保障制度类型的国家,其管理体制在现阶段都出现向全统筹模式迈进的倾向。中国基本医疗保障制度下,全统筹模式比分离模式表现出更多的优越性。中国应建立统筹管理医疗保障与医疗服务的卫生行政管理新体制,整合基本医疗保险经办资源,并推行卫生行政部门监管机制改革。     

对农牧人口医疗补助的公平性问题的调研

利用中央和各级政府的财政转移，西藏自治区建立了覆盖全部农牧人口的基本医疗保障制度。然而，西藏周边地区居民尚未享受类似的基本医疗保障，因而产生了医疗补助的公平性问题。消除这一现象的关键。首先在于根据居民健康脆弱性指标，制定地区级差补助标准，然后以建立医疗救济制度为起点。逐步推广合作医疗制度，循序渐进地扩大社会基本医疗保障覆盖面。     

降低医疗开支 减轻人群负担

随着经济发展、技术进步、基本医疗保障制度发展,医疗费用都会有一定幅度增长。但医药费用的上涨必须与经济发展水平相协调,与政府财政、基本医疗保障和个人的承受能力相适应。短时间内医药费用过快上涨,将会影响民众的切身利益。     

我军医疗体制现状及改革举措

我国医改已经进入深水区,目前军队也在进行医疗改革.最大程度发挥军队医疗的效能,满足军人及军队所属相关人员的合理医疗需求是一个重要的领域.通过分析我军医疗保障制度现状,剖析军队医疗保障制度存在的问题及原因,并提出相应的整改措施和建议.     

某市医疗欠费状况调查及对策研究报告

目的描述和评价某市医疗欠费情况,分析导致医疗欠费发生的主要原因,处理过程中存在的问题,提出有效的对策建议.方法采用分层随机抽样方法,抽出19所医疗机构,进行问卷调查和统计学分析.结果医疗欠费已经对部分医疗机构产生一定的影响;欠费额有逐年增加趋势;医疗保障制度有待进一步完善;欠费处理效果不够理想;欠费损失后果全部由医疗机构来承担,政府、社会缺乏救助办法.结论政府应完善社会医疗保障体系;控制医疗费用的过快增长;提高医疗服务质量;采取多种手段,加大欠费追讨力度.     

深化医院改革 保障基本医疗

从以定额结算为核心,深化医院内部配套改革,逐步建立良性运行机制;加强宣传力度,统一思想认识,增强医院干部职工主动适应、积极参与职工医疗保障制度改革的自觉性;转变卫生行政部门职能,加大宏观调控力度等三个方面总结了在职工医疗保障制度改革试点过程中深化医院改革,保障基本医疗的经验。同时提出了需要进一步探讨和完善的问题:进一步完善医疗费用支付办法,使之更加科学、合理、可行;进一步完善医院补偿机制;加快制订区域卫生规划,合理配置医疗卫生资源;继续完善医疗服务供方制约机制。     

基本医疗及其需要量的研究

目的：界定基本医疗概念,建立基本医疗服务项目,确定基本医疗需要量,划定公立医院病床、医生比例,为政府制定规划、实施监督考核,真正实现人人享有基本医疗保障提供科学依据.方法：采用社会学定性、定量研究的方法,进行Delphi调查及专家小组论证,问卷调查以数学模型测算.结果：确定了基本医疗概念;心脏病、脑血管病、呼吸系统疾病、肌肉骨骼系统疾病、外伤中毒、内分泌营养免疫疾病及妊娠分娩病为临床基本医疗服务疾病;需要现有37.7%的病床、78.4%的医生来满足基本医疗.结论：基本医疗的概念是动态的,它的内涵会随着经济水平的提高,人群对医疗需求期望值的增加而不断扩大.     

试析大型综合医院在社区医疗服务中的作用

根据国家城市卫生服务体系改革的原则及对基层医院和大医院的功能定位,分析大型综合医院在社区医疗服务中的作用。指出大型综合医院应加强与城市基层医院的联系,建立全科医生培训基地,为社区医疗服务输送适用人才,建立切实可行的转诊制度,成为社区医疗服务的坚强后盾,提高社区医疗服务的质量和水平,促进社区医疗服务的发展。     

Market reforms and public incentives: finding a balance in the Republic of Macedonia

The Republic of Macedonia is undertaking sweeping reforms of its health sector. Funded by a World Bank credit, the reforms seek to improve the efficiency and quality of primary health care (PHC) by significantly strengthening the role of the market in health care provision. On the supply-side, one of the key reform proposals is to implement a capitation payment system for PHC physicians. By placing individual physicians on productivity-based contracts, these reforms will effectively marketize all PHC provision. In addition, the Ministry of Health is considering the sale or concessions of public PHC clinics to private groups, indicating the government's commitment to marketization of health care provision. Macedonia is in a unique position to develop a new role for the private sector in PHC provision. The private provision of outpatient care was legalized soon after independence in 1991; private physicians now account for nearly 10% of all physicians and 22% of PHC physicians. If the reforms are fully realized, all PHC physicians-over 40% of all physicians-will be financially responsible for their clinical practices. This study draws on Macedonia's experience with limited development of private outpatient care starting in 1991 and the reform proposals for PHC, finding a network of policies and procedures throughout the health sector that negatively impact private and public sector provision. An assessment of the effects that this greater policy environment has on private sector provision identifies opportunities to strategically enhance the reforms. With respect to established market economies, the study finds justification for a greater role for government intervention in private health markets in transition economies. In addition to micro-level payment incentives and administrative controls, marketization in Central and Eastern Europe requires an examination of insurance contracting procedures, quality assurance practices, public clinic ownership, referral practices, hospital privileges, and capital investment policies.     

State-sponsored primary health care in Africa: the recurrent cost of performing miracles

In this paper the author suggests that the design and execution of ongoing and future primary health care (PHC) interventions in Africa could be improved by more comprehensive and realistic assessments of the recurrent costs of alternative approaches to providing given levels of health care benefits. He develops the distinction between development and recurrent cost elements; distinguishes between marginal and average costs of interventions; identifies elements of social opportunity cost that are frequently overlooked in assessing project costs and shows how their inclusion magnifies the aggregate social cost of interventions featuring recurrent involvement of state agents; suggests that the perception of benefits conveyed by state-sponsored PHC programs to rural populations is limited, especially in relation to the true social costs; and discusses the implications of the above analysis for future PHC strategy.     

Sustainable primary health care services in rural and remote areas: innovation and evidence

Objective: To highlight how evidence from studies of innovative rural and remote models of service provision can inform global health system reform in order to develop appropriate, accessible and sustainable primary health care (PHC) services to ‘difficult‐to‐service’ communities. Methods: The paper synthesises evidence from remote and rural PHC health service innovations in Australia. Results: There is a strong history of PHC innovation in Australia. Successful health service models are ‘contextualised’ to address diverse conditions. They also require systemic solutions, which address a range of interlinked factors such as governance, leadership and management, adequate funding, infrastructure, service linkages and workforce. An effective systemic approach relies on alignment of changes at the health service level with those in the external policy environment. Ideally, every level of government or health authority needs to agree on policy and funding arrangements for optimal service development. A systematic approach in addressing these health system requirements is also important. Service providers, funders and consumers need to know what type and level of services they can reasonably expect in different community contexts, but there are gaps in agreed indicators and benchmarks for PHC services. In order to be able to comprehensively monitor and evaluate services, as well as benchmarks, we need adequate national information systems. Conclusions: Despite the gaps in our knowledge, we do have a significant amount of information about what works, where and why. At a time of global PHC reform, applying this knowledge will contribute significantly to the development of appropriate, sustainable PHC services and improving access.     

Primary health care in a multi-level perspective: towards a research agenda

The authors propose to view primary health care (PHC) from a multi-level perspective. Studying how PHC is conceived and implemented at different levels of social organization (e.g. in international agencies, national governments, regional centres of health care and local communities) will reveal which interests may be competing in the planning and execution of what broadly and conveniently is called 'PHC'. Mapping out these conflicting views and interests will contribute towards a better understanding of how PHC works or why it does not work and provide suggestions for a more effective and equitable PHC. Five themes are proposed for a multi-level research approach: (1) vertical versus horizontal organization of PHC: (2) the role of medical personnel in PHC; (3) the distribution of pharmaceuticals; (4) the integration of traditional medicine in PHC; and (5) family planning.     

Evaluation of primary health care reform in Estonia

Estonia began to reform its health care system by reorganizing primary health care (PHC). Ten years ago, the health care system was inefficient, supply was biased towards institutional care, and PHC was almost non-existent in the western understanding: it was provided by different specialists in policlinics, and the financial basis of the system was in crisis. The reform had the following aims: to develop PHC by introducing family medicine, to guarantee the whole population access to family doctors' services, and to secure stable funding for these services. In 1998, a new phase in the reform was introduced through the creation of a new funding system for primary care services. The aim of this paper is to present a practically applicable set of indicators to evaluate PHC reform in terms of health economics criteria and then to apply these indicators in evaluation of the Estonian PHC reform.     

What is ‘primary’ about primary health care?

In many countries health policy and health system reforms are giving primary health care (PHC) a more prominent role in the health system. As a result, policy towards PHC is becoming more contested and is posing bigger and more contradictory demands of PHC (e.g. that PHC should at once be more accessible and of higher quality and cheaper). International and professional bodies have responded to the debates about what the role of PHC should be partly by promulgating redefinitions of ‘primary health care’. However, such definitions tend simply to assert a policy standpoint of their own, thereby begging the policy questions noted above. This paper tests some better-known current definitions of ‘primary health care’ against various criteria of validity, including the requirement not to prejudge the aforementioned policy debates. It then constructs a fresh definition from the materials which survive that test and from a general theory of the function of health care. The resulting definition is: Primary health care: goods or services which individuals obtain for maintaining their personal functioning or preventing pain; which they can access directly and receive in settings which allow them to continue their other normal activities of daily life at home and (when applicable) at work. Whilst its present conclusions relate specifically to PHC, the paper’s method for generating and testing definitions applies to health services research generally.     

Where there is no policy: governing the posting and transfer of primary health care workers in Nigeria

The posting and transfer of health workers and managers receives little policy and research attention in global health. In Nigeria, there is no national policy on posting and transfer in the health sector. We sought to examine how the posting and transfer of frontline primary health care (PHC) workers is conducted in four states (Lagos, Benue, Nasarawa and Kaduna) across Nigeria, where public sector PHC facilities are usually the only form of formal health care service providers available in many communities. We conducted in‐depth interviews with PHC workers and managers, and group discussions with community health committee members. The results revealed three mechanisms by which PHC managers conduct posting and transfer: (1) periodically moving PHC workers around as a routine exercise aimed at enhancing their professional experience and preventing them from being corrupted; (2) as a tool for improving health service delivery by assigning high‐performing PHC workers to PHC facilities perceived to be in need, or posting PHC workers nearer their place of residence; and (3) as a response to requests for punishment or favour from PHC workers, political office holders, global health agencies and community health committees. Given that posting and transfer is conducted by discretion, with multiple influences and sometimes competing interests, we identified practices that may lead to unfair treatment and inequities in the distribution of PHC workers. The posting and transfer of PHC workers therefore requires policy measures to codify what is right about existing informal practices and to avert their negative potential. © 2016 The Authors The International Journal of Health Planning and Management Published by John Wiley & Sons Ltd     

Validation of ACG Case-mix for equitable resource allocation in Swedish primary health care

Background  

Adequate resource allocation is an important factor to ensure equity in health care. Previous reimbursement models have been based on age, gender and socioeconomic factors. An explanatory model based on individual need of primary health care (PHC) has not yet been used in Sweden to allocate resources. The aim of this study was to examine to what extent the ACG case-mix system could explain concurrent costs in Swedish PHC.