医疗保障制度改革与老年人保健

目前 ,人口的老龄化日益加剧 ,老年人的卫生保健问题是人口老龄化进程中最为突出的问题之一。近几年 ,世界各国纷纷对医疗保障制度进行一系列改革 ,老年人的医疗保健问题成为改革的重点 ,本文试就中国医疗保障制度改革对老年人保健的影响作一初步探讨。一、中国医疗保障制度改革进展及其与老年人保健的关系中国医疗保障制度的改革可分为以下两个阶段 :(１)１９９４年以前 ,改革的主要目标是控制医疗费用的过快增长。采取的措施包括对需方实行费用分担和对医院加强医疗服务供方费用约束两方面。 (２)１９９４年初 ,国家体改委、财政部、劳动…     

深化上海市职工医疗保障制度改革的主要措施和步骤

介绍上海市职工医疗保障制度改革在实行医疗保险费用社会统筹、建立个人医疗帐户、完善老年医疗保障制度、调整企业医疗机构、推动多层次的医疗保障等方面的措施以及坚持由国家、单位和个人合理分担医疗费用,增加个人自我保障责任;实行社会化管理;理顺医院经营机制,提高医院服务质量的改革步骤。     

大学生医疗保障状况调查

随着我国医疗保障体制的建立和不断完善,城镇职工、农民的医疗保障体系已经基本建立起来,在校大学生的医疗保障体系尚未健全[1],学生因就医费用昂贵,患病后就医困难仍然是主要问题.     

城镇居民医疗保障体系研究

当前 ,医药卫生体制改革已经进入全面实施阶段 ,需要切实加强对基础性、政策性、前瞻性问题的研究 ,尤其是医疗保障体系方面 ,及时预见和解决改革中的一些重点和难点问题 ,如研究不同收入水平人群医疗保障及管理问题 ,探索结构合理、功能互补、切实可行的医疗保障体系等 ,使之不断完善和发展。一、城镇居民医疗保障体系的构成１．城镇职工基本医疗保险和企业补充医疗保险。企业补充医疗保险的主要形式是职工大额医疗费用补助 ,据统计 ,企业职工每年医疗费用支出超出“封顶线”以上的人数约３００万 ,约占城镇职工总数的２ % ,占城镇总人口的…     

消息

中华医院管理杂志社定于2007年9月中旬(地点待定)召开全国医院管理学术研讨会,会议以“医疗卫生体制改革和医院管理创新与发展”为主题,现向全国征文。一、征文内容①基本卫生保健制度的建立与完善;②多层次医疗保障体系的建立及其对医院管理的要求;③国家基本药物制度的     

军队医疗保障制度改革现状及发展趋势

军队医疗保障制度是指在一定的历史条件下形成的军队人员医疗待遇、医疗服务保障基本方式、医疗经费运行机制等方面的制度体系。其核心是费用制度。中国人民解放军医疗保障制度,在提高医疗经费标准、加强医疗费用管理、建立医疗特殊项目补助经费等改革的基础上,2004年5月我军实施了新的医疗保障制度,其主要内容是:①分类保障;②合理医疗;③统定管理;④持卡就医。⑤远离军队医疗机构人员门(急)诊实行社会化保障。目前,制度运行基本顺畅,正在寻求从以下几个方面进行深化改革:更多地依托地方医疗机构为军队服务,完善军人退役医疗保险制度,加强军人大病费用管理,规范基层部队医疗服务管理。     

励精图治，打造精品期刊

在世界范围内，卫生与卫生保健已经成为非常重要的经济、政治和社会问题。大多数国家的卫生保健费用上涨快速，医疗制度不断变革，每个国家都希望找到市场机制与非市场机制在医疗服务中的平衡点，建立一种既能确保医疗平等与质量，又能提高医疗效率的医疗体系。《中国卫生产业》应运而生，承担着交流管理经验、宣传理论知识、展示改革成果，发布政策信息的媒介任务。     

军队医疗保障制度改革现状及发展趋势

军队医疗保障制度是指在一定的历史条件下形成的军队人员医疗待遇、医疗服务保障基本方式、医疗经费运行机制等方面的制度体系.其核心是费用制度.中国人民解放军医疗保障制度,在提高医疗经费标准、加强医疗费用管理、建立医疗特殊项目补助经费等改革的基础上,2004年5月我军实施了新的医疗保障制度,其主要内容是:①分类保障;②合理医疗;③统定管理;④持卡就医.⑤远离军队医疗机构人员门(急)诊实行社会化保障.目前,制度运行基本顺畅,正在寻求从以下几个方面进行深化改革:更多地依托地方医疗机构为军队服务,完善军人退役医疗保险制度,加强军人大病费用管理,规范基层部队医疗服务管理.     

关于构建基本卫生保健制度若干问题的思考

从分析基本卫生保健制度的概念和内涵入手,讨论构建基本卫生保健制度要抓住的基本卫生保健服务体系和医疗保障体系等几个重点环节,论述了政府在基本卫生保健制度构建中应承担的责任,讨论了在构建基本卫生保健制度过程中必须关注的卫生管理体制、医疗保障制度支付管理和全科医学等几个重点问题。     

着力缓解看病难看病贵——医改开出四张“药方”

建设覆盖城乡居民的基本卫生保健制度 建设多层次医疗保障体系 建立国家基本药物制度 建立科学规范的公立医院管理制度[编按]     

Health care reforms in the French hospital system

The French health care system, like other health care systems, entered the 1990s in a state of flux. During the 1980s, attempts to curb health care expenditure had a limited impact with the liberal and pluralist values of the health system undermining reform strategies. In 1991 the French government introduced a new hospital reform which had four main strands: rationalizing public and private health care provision; introducing a medical logic into the hospital service; increasing hospital autonomy and strengthening participation and involvement in the hospital system. However, these reforms left untouched the financing of the health service. Consequently there remains a need for a more fundamental reform of the management and financing of the French health care system.     

青海省湟中县医疗联合体改革实践

我国西部经济相对不发达的县级地区普遍面临着县域内医疗服务体系碎片化,乡镇卫生院医疗卫生服务能力严重不足的问题。在有限的公共财政资源约束下,如何提高乡镇卫生院服务能力,改善医疗服务体系的服务质量、连续性和便利性成为我国县级医疗卫生体系改革的现实挑战。本文以青海省湟中县为典型案例,调研当地通过医疗服务联合体纵向整合县域医疗资源的改革实践,分析其行政管理一体化、人力资源整合、双向转诊、信息系统互联互通以及资源与检查结果共享等方面的改革措施及相应结构特点,为我国类似地区改革提供参考案例。     

Poor medicine for poor people? Assessing the impact of neoliberal reform on health care equity in a post-socialist context

Abstract

Driven in part by a resurgent interest in social inequality and health, and in part by increasing scrutiny of the social and health consequences of neoliberal economic reform, principles of health equity and social justice, the centerpieces of the Health for All strategy drafted at Alma Ata in 1978, are once again at center stage in global public health debates. Whether and how equity in access to health care can be maintained in a context of market-based health sector reform has not been systematically addressed, particularly from the perspective of local communities. This paper will explore how health reform affects health care in post-socialist Mongolia. Through a mixed-methods household-based study of low-to-middle income communities in urban and rural Mongolia we find that despite explicit and concerted efforts to reduce inequities, the reform system is unable to provide equitable health care either vertically or horizontally. Emphasis on privatization of the secondary and tertiary sectors of the system, coupled with deployment of universally-accessible, but from a clinical standpoint, limited, version of essential primary care, produces a fragmented system. Particularly for the vulnerable poor, access to services beyond the primary care system is compromised by financial, opportunity, and informational cost barriers. This research suggests that new models of health reform are needed that will effectively bridge the growing gaps between public and private resources, primary and secondary and/or tertiary care, and clinical and public health services.     

The current state of health care in the former Soviet Union: implications for health care policy and reform.

OBJECTIVES. Given the many profound health care problems facing Russia and the other former Soviet republics, there are a number of fundamental policy questions that deserve close attention as part of the reform process. METHODS. Summary data regarding Soviet health care issues were drawn from government agency reports, scholarly books and journals, recent press reports, and the authors' personal research. RESULTS. Smoking, alcohol, accidents, poor sanitation, inadequate nutrition, and extensive environmental pollution contribute to illness and premature mortality in Russia and the other newly independent states. Hospitals and clinics are poorly maintained and equipped; most physicians are poorly trained and inadequately paid; and there is essentially no system of quality management. While efforts at reform, which emphasize shifting to a system of "insurance medicine," have been largely unsuccessful, they have raised several important policy issues that warrant extensive research and discussion. CONCLUSIONS. Without considering the implications and consequences of alternative policy directions, Russia and the other states face the very real possibility of developing health care systems that improve the overall level of care but also incorporate limited access and escalating costs. Russian health care reform leaders can learn from the health care successes in the West and avoid repeating our mistakes.     

卫生体系改革评价研究的进展与实践

卫生体系改革评价对判断改革目标实现程度、完善调整改革政策、促进卫生体系持续发展具有重要意义。本文综述了卫生体系改革评价研究的主要进展与特点;重点介绍了中澳卫生与艾滋病项目"医药卫生体制改革评价研究"的主要内容与发现,总结了新一轮医改的总体进展,并针对几个重点领域进行了专题评价研究。分析了我国开展医改评价研究面临的主要问题,主要有对评价研究重视不够,评价主体比较单一,评价研究的框架和指标体系不够完善,研究方法薄弱,评价信息数据收集困难等。建议将评价研究作为医改过程的必要环节和内容,促进评价的制度化和常态化;树立正确的医改评价理念,将提高人民健康水平作为根本目标;持续完善评价框架和指标体系,重点转向绩效结果评价;加强方法学研究,不断提高政策评价的能力与水平。     

What happened to long-term care in the health reform debate of 1993-1994? Lessons for the future.

During 1993 and 1994, the United States debated but did not enact major health care reform. Although the reform efforts focused on providing health coverage for the uninsured and controlling acute care costs, many proposals included substantial long-term care initiatives. President Clinton proposed creating a large home-care program for severely disabled people of all ages and all income groups, among several other initiatives. By stressing non-means-tested public programs, the president's plan was a major departure from the Medicaid-dominated financing system for long-term care. In designing the long-term care component, the Clinton administration addressed many of the basic policy choices that must be decided in all reform efforts, including whether initiatives should be limited to older people or cover people of any age, how to balance institutional and noninstitutional care, whether to rely on government programs or on the private sector, and how to control costs. Analyzing the political and intellectual history of long-term care during the health reform debate provides lessons for future reform.     

What Happened to Long‐Term Care in the Health Reform Debate of 1993–1994? Lessons for the Future

During 1993 and 1994, the United States debated but did not enact major health care reform. Although the reform efforts focused on providing health coverage for the uninsured and controlling acute care costs, many proposals included substantial long-term care initiatives. President Clinton proposed creating a large home-care program for severely disabled people of all ages and all income groups, among several other initiatives. By stressing non-means-tested public programs, the president's plan was a major departure from the Medicaid-dominated financing system for long-term care. In designing the long-term care component, the Clinton administration addressed many of the basic policy choices that must be decided in all reform efforts, including whether initiatives should be limited to older people or cover people of any age, how to balance institutional and noninstitutional care, whether to rely on government programs or on the private sector, and how to control costs. Analyzing the political and intellectual history of long-term care during the health reform debate provides lessons for future reform.     

Prisons and health reforms in England and Wales

Prison health in England and Wales has seen rapid reform and modernization. Previously it was characterized by over-medicalization, difficulties in staff recruitment, and a lack of professional development for staff. The Department of Health assumed responsibility from Her Majesty's Prison Service for health policymaking in 2000, and full budgetary and health care administration control were transferred by April 2006. As a result of this reorganization, funding has improved and services now relate more to assessed health need. There is early but limited evidence that some standards of care and patient outcomes have improved. The reforms address a human rights issue: that prisoners have a right to expect their health needs to be met by services that are broadly equivalent to services available to the community at large. We consider learning points for other countries which may be contemplating prison health reform, particularly those with a universal health care system.     

The impact of state behavioral health reform on Native American individuals, families, and communities

In 2005, the State of New Mexico undertook a sweeping transformation of all publicly funded behavioral health services. The reform was intended to enhance the cultural responsiveness and appropriateness of these services. To examine achievement of this objective, we conducted a qualitative study of the involvement of Native Americans in reform efforts and the subsequent impacts of reform on services for Native Americans. We found that the reform was relatively unsuccessful at creating mechanisms for genuine community input or improving behavioral health care for this population. These shortcomings were related to limited understandings of administrators concerning how tribal governments and health care systems operate, and the structural limitations of a managed care system that does not allow flexibility for culturally appropriate utilization review, screening, or treatment. However, interaction between the State and tribes increased, and we conclude that aspects of the reform could be strengthened to achieve more meaningful involvement and service improvements.     

卫生财政学概念的涵义、范围领域、基本特征与地位作用(上)

我国的医药卫生体制改革总体方案设计正处于关键时期．卫生筹资模式、卫生总费用构成状况和政府在卫生保健服务中承担的责任是当前的核心议题，卫生财政和卫生财政学应运而生卫生财政（包括医疗财政）是财政体制创新的必然结果，是财政体制处于由以分税制为基础的分级财政体制向公共财政体制转型的过渡性产物，通过简要讨论卫生财政概念及其内涵、外延，描述卫生财政学的学科体系．确定卫生财政学的研究范围、研究领域和关键性研究议题，概括卫生财政的基本特征和国际发展历史经验．分析卫生财政的基本功能与地位作用等基础理论政策议题，为医药卫生体制改革和构建和谐社会、和谐医惠关系提供了崭新的改革思路。