香港医疗融资方案之探讨

香港所面对的情况和其他国家相似——人口增长而又不断老化,造成对服务需求日增;市民生活富裕而对服务有更高期望;同时亦有新的医疗科技,可进一步改善市民健康,但成本颇高。因此,香港的公立医疗体制正面对颇大的压力。由此而衍生的问题,是医疗体制能否长期得以维持,而香港的公立医疗服务又怎样以有限的财政预算应付无尽的需求呢?要应付这些问题,香港政府有需要检讨融资问题和可行的融资方案。作为引言,我想与各位首先解释一些关于香港人健康状况的统计数据。     

香港特区公营医院运行机制评估及对内地的启示

回顾香港医疗融资的发展历程并简述香港公营医院的运营状况与开支构成比,重点分析香港公营医院的管理机构——香港医院管理局,研究其宗旨任务与目标策略相结合的管理医院管理战略,跟踪其主要经费来源的变化趋势,对其财务状况进行深入探究并进行预测。在对香港公营医院运行机制进行评估的基础上,探讨香港公营医院存在的问题以及对内地的启示,为内地医院管理机构借鉴香港逐步建立以政府投入为主体的医疗融资体系提供参考。     

中国城镇医疗体制改革前后的医疗融资对比

医疗融资是整个医疗体制的重要组成部分,具有筹集资金、化解风险以及支付费用的功能,其中社会医疗保险是医疗融资的主要渠道.文章从医疗融资方法、融资决策权分配、支付手段及成本控制等方面,比较了改革前后,我国城镇医疗融资体制的发展变化.改革前,政府最终预算融资与全民就业政策,能够保证以就业为基础的"劳保-公费医疗"保险在城镇地区实现全覆盖;改革后,财政分权制、分税制及国有企业改革改变了经济基础,使得同样以就业人口为目标的城镇职工基本医疗保险无法实现全覆盖.扩大现有社会医疗保险基金的风险化解与转移能力,努力推行全体城镇居民基本医疗保险,以及加大财政,特别是中央财政的支持力度是未来医疗融资改革的方向与重点.     

私人医生何时走进寻常百姓家?

在人们对自己的健康越来越重视的今天,私人医生正逐步走进人们的视线。在国外,私人医生已是一个很成熟的职业,可是在我国,对医疗消费者来讲,这还是一个新生事物。但是私人医生却是一个牵涉到医疗体制的大问题,有关医疗机构能否提供私人医生的服务?关注健康的人们能否接受私人医生?私人医生能够提供什么样的服务?     

中国城镇居民的医疗融资支付现状分析

该文从医疗体制供给与需求的角度，提出了医疗配送、医疗融资以及医疗支付体系的框架，并重点介绍了医疗融资支付体系的组成内容和基本功能。作者以此为基础，从医疗融资的资金本源、代理机构和医疗费用支出的总量与结构的角度，具体分析了我国居民医疗融资支付体系的现状，并重点从融资方法、支竹安排、融资决策权与成本控制角度剖析了我国城镇主流的医疗保险，即“城镇职工基本医疗保险”的融资结构。最后，从效率与公平的永恒主题对我国城镇居民的医疗融资现状进行了简单评价，并提出未来进一步实现全面覆盖的政策建议。     

浅谈医疗设备融资租赁

对于急于购置医疗设备而资金相对短缺的医疗机构,医疗设备融资租赁是一种不错的选择。本讨论阐述了医疗设备融资租赁的基本概念及特点,介绍了医疗设备融资租赁的程序,分析了在采用融资租赁过程中应注意的问题。     

融资租赁医疗设备探微

随着科学技术的高速发展，人才、设备和管理已成为现代医院的核心竞争力。现代医疗手段越来越依赖于医疗设备，先进、精确、高效的医疗设备在医院诊断、治疗及教学过程中，发挥了极其重要的作用。特别是在全面建设小康社会的今天，广大人民群众对医疗服务的要求越来越高，但医疗设备普遍价格昂贵，仅靠医院自身的财力往往力不从心，难以适应发展的新需要。如何解决设备的购置和资金短缺的矛盾呢?我们认为：融资租赁就是一个行之有效的途径。     

古巴医疗体制发展历程及其启示

"财富-健康"的因果关系--这个曾经被人们普遍接受的观点现在受到了挑战.古巴作为中低收入国家,其国民健康状况却达到了发达国家的水平.介绍了古巴医疗体制建立与发展的不同阶段,从历史角度理解古巴医疗体制的概貌;同时勾勒了医疗配送和医疗融资体系,从医疗供给与需求的角度描述了古巴的公立医疗体制;最后从古巴的成功医疗体制经验中提出了医疗公平性对发展中国家的重要性、市场手段未必能够保证效率、基础医疗是成功医疗体制的基石,以及医疗供求市场的统一与分离的重新思考等4点对中国的有益启示.     

古巴医疗体制发展历程及其启示

财富-健康的因果关系——这个曾经被人们普遍接受的观点现在受到了挑战。古巴作为中低收入国家,其国民健康状况却达到了发达国家的水平。介绍了古巴医疗体制建立与发展的不同阶段,从历史角度理解古巴医疗体制的概貌;同时勾勒了医疗配送和医疗融资体系,从医疗供给与需求的角度描述了古巴的公立医疗体制;最后从古巴的成功医疗体制经验中提出了医疗公平性对发展中国家的重要性、市场手段未必能够保证效率、基础医疗是成功医疗体制的基石,以及医疗供求市场的统一与分离的重新思考等4点对中国的有益启示。     

医疗设备融资租赁及会计处理

以融资租赁方式引进医疗设备有利于提高医院资金利用率、加快设备更新、盘活医院固定资产，促进医院的快速发展。文章在对医疗设备融资租赁做简单概述的基础上，讨论了医疗设备融资租赁的特点，医疗设备融资租赁对医院的作用，以及医疗设备融资租赁的会计处理问题。     

香港地区医疗体制对内地的借鉴意义

香港医疗体制的特点是高福利、低收费、公益性强。与香港相比,内地虽然医疗资源相对丰富,医疗效率较高,但公立医院得到的政府财政补偿不足,导致公立医院运行困难、公益性淡化。借鉴香港的医疗体制,提出逐步建立双向转诊机制;建立社会医疗保障补充机制;建立统一的医疗信息系统;强化整体医疗卫生概念;强化行业管理,建立和完善考核评审机制;建立良性运行机制,保障可持续发展的能力。     

全球最有效率的医疗卫生体系如何应对挑战?——香港特别行政区的医疗管理体制、医疗改革举措及对内地的启示

我国医药卫生体制改革取得了有目共睹的成绩,在深化医改的过程中,可以更多参考借鉴其他华人社会的成功经验并汲取其教训。香港特别行政区的医疗卫生体系蜚声国际,高居"全球最有效率卫生体系"之冠。本文主要评析香港特区的医疗管理体制,遇到的挑战,以及近年来的重要医改举措,并总结其对内地医改的启示。香港的医疗卫生治理结构充分实现了"管办分开",解决了"九龙治水"问题,医管局管理体制具有较高的效率和专业性。但是香港特区医疗系统也面临诸多挑战,特区政府近年来推行了自愿医保、公私营协作计划、长者医疗券等若干医改政策,其中许多改革理念和政策工具可供内地医改借鉴。     

新时代下的健康需要、卫生服务需求与利用：一个新的分析框架

健康需要、卫生服务需求与利用是卫生服务研究中的核心主题,因为其与卫生服务筹资、分配、提供、治理等卫生服务体系发展的核心问题紧密相关,一定程度上也会影响卫生政策的价值取向和权衡。在实际研究中,出现了三者概念混用和滥用现象。因此,正确界定三者的概念内涵、厘清概念间关系,对丰富健康需要理论研究、推动卫生服务体系可持续发展具有重要意义。     

Vouchers for primary healthcare services in an ageing world? The perspectives of elderly voucher recipients in Hong Kong

Considering the ageing population in economically advanced regions across the world, measures are necessary to enhance the health of the older population as well as contain public healthcare spending. Hong Kong implements the Elderly Health Care Voucher Scheme (EHCVS), providing older people aged 65 or above an annual subsidy of visiting private healthcare service providers for chronic disease prevention and management. The services also aim at reallocating demand from the public to private sector as well as improve quality of services. This qualitative study explored the experiences of EHCVS recipients (n = 55, aged 61–94) with eight focus group interviews in Hong Kong in the year 2016. Convenience sampling was used. Research questions were: (1) Why do older people choose not to use EHCVS for preventive as well as disease management services among older people in Hong Kong? (2) What are the barriers to reallocating demand from the public to private sector? (3) In what ways did EHCVS improve the quality of primary care services for older people? Using a deductive and inductive approach, eight qualitative themes were identified. Findings suggested that the non‐targeted services and inadequate knowledge on EHCVS deterred older people from using the vouchers for disease management and prevention. The relatively expensive private services, lack of trust in the private sector, low public clinic fees and good services quality of the public sector, together with inadequate private practitioners in the healthcare market were barriers that hinder demand reallocation. Nevertheless, the quality of primary care services had been improved after the implementation of EHCVS with shortened wait times and opportunities to discuss health‐related issues with private practitioners. Findings were discussed with practice, policy and research implications.     

The Armenian healthcare system: recent changes and challenges

Background  Armenian healthcare reforms have been carried out since independence in 1991, but achieved their full scale starting in 1995–1996. Although the healthcare system has already been modified and changed for 10 years, there is a lack of research in this regard. Objectives  This paper aims to present the organization of the healthcare system in Armenia, its changes and challenges throughout the reform process. Methods  This paper is mainly based on a review of the relevant professional literature, a review and interpretation of legal acts in the healthcare field, and a review of research and assessment works done by several international and local organizations. Results  There are still large numbers of elements typical for the Soviet Semashko model in Armenian healthcare structures. Implemented reforms have separated the institutions of the public payer and the providers, but did not manage to change the model of financing to be based on compulsory insurance. The level of financing is similar to the average in Central and Eastern Europe, but is based mainly on out-of-pocket payments contributing to about 80% of all system resources. The informal payments reach even 45% of expenditures. The structure of hospital beds remains ineffective, and there are still no mechanisms of increasing the quality of services. Privatization has been applied, but the role of private providers is still limited. Conclusions  The reforms have not caused satisfactory improvement in healthcare performance, although the health indicators are better than at the beginning of the transformation period. The stability of the reforming processes in previous years as well as the engagement of international institutions is a chance for positive changes in the near future.     

Interpreting the effectiveness of a national antibiotic policy and comparing antimicrobial use between countries

Rubella infection in early pregnancy is associated with severe consequences in the developing fetus. In Hong Kong, 8-11% of women of child-bearing age are still susceptible to rubella infection. Therefore, rubella immune status of healthcare workers who may have contact with pregnant women is of particular concern. Rubella immunity of healthcare workers in a Department of Obstetrics and Gynaecology was analysed. In the one and a half years of study, 134 healthcare workers voluntarily submitted blood samples for immunity determination and 16.4% of them were susceptible to rubella infection. A substantial proportion of healthcare workers of childbearing age (14%) was negative for rubella antibody. Susceptible healthcare workers have a risk of acquiring and subsequently transmitting the potentially teratogenic rubella infection to their patients. There is a need to review the rubella immunization policy for healthcare workers in Hong Kong.     

Economic development and the health care system in Hong Kong

This article describes parallel developments of the Hong Kong economy and its health care system. The purpose is to illustrate how the Hong Kong health system evolved in response to external and internal pressures generated by economic prosperity. The Hong Kong system illustrates the importance of clear policy making in the face of these pressures. In particular, issues of investment, financing and distribution of health services are examined in relation to hospital cost control and service accessibility. In the past, health care costs in Hong Kong have been controlled at the expense of limited accessibility of health services. At present, Hong Kong policy-makers are faced with the challenge of maintaining a sharp focus on cost control as they face pressure to expand and improve health care coverage for the citizens. So far they have responded by emphasizing management efficiency through reorganization. It remains to be seen whether this strategy can be successful without passing increased health care costs to the consumers.     

Global budgeting of hospitals in Hong Kong.

Policy-makers in industrialized countries face the dilemma of having to contain soaring hospital costs while resisting any reduction in the quality and quantity of hospital services. Among the many hospital financing systems, centralized control via global budgeting is advocated by some to be the most effective in containing hospital costs. Containing hospital costs, however, is but one aspect of the trade-off between cost containment and quality of care. The hospital financing system of Hong Kong provides some insights into the extent to which cost control can be achieved through global budgeting; and its impact on the accessibility of hospital care. The case of Hong Kong highlights three necessary conditions for effective cost control: (1) the payer must have a clear policy stance on overall public spending; (2) the payer must have a clear policy stance on the importance of hospital care relative to other goods and services; and (3) the payer must also have the will and ability to limit hospital spending within finalized global budgets. However, successful cost containment in Hong Kong affects the accessibility of hospital care. In a time of population growth and economic prosperity, new community needs seem to have preceded government plans and actions to build hospital facilities.     

英国、新加坡和中国香港全民医保的运行及启示

作为医疗保障制度较为健全的国家和地区,英国、新加坡和中国香港三地的全民医疗保障体系经常成为学术界的研究对象。英国是全民免费医疗的典范,新加坡是政府主导的混合型医疗保障模式的代表,香港则凭借着质优价廉的公立医院服务享誉全球。本文将从卫生筹资的公平性、个人的可负担能力、医疗保障的覆盖模式、卫生筹资的可持续性以及个人责任的承担这五个核心维度来评估三地医疗保障系统的优越性和局限性,以期为我国新时期医疗改革的深化提供借鉴与参考。