社区卫生服务PPP模式中社会资本机会主义行为及监管研究

目的:探讨社区卫生服务领域引入PPP模式的社会资本可能产生的机会主义行为和监管问题,在考虑监管成本的制约下研究政府部门监管的合适时机,以达到效益的最大化。方法:采用博弈分析方法对社区卫生服务引入PPP项目时社会资本方可能产生的机会主义行为进行分析,在对政府和社会资本间的行动策略做出合理前提假设后,构建政府部门与社会资本之间的博弈模型,探讨政府部门监管的最佳时机和策略。结果与结论:在社区卫生服务PPP模式中,社会资本方预测到政府部门监管的概率p*(r2_-r_1)/(r_2-r_1-c_2)的情况下,采取机会主义行为的策略则会获得最优效用。而在政府部门预测到社会资本方采取机会主义行为的概率q* c_1/2R_1时,选择监管的行为策略会获得最优效用。     

某市社区卫生服务机构人力资源现状调查

[目的]了解社区卫生服务机构人力资源现状以及对人才需求的模式,为今后大力发展社区卫生服务机构提供理论依据。[方法]采用自制调查表和访谈提纲,抽样调查全市部分社区卫生服务机构的人员情况。[结果]平均每家社区卫生机构在岗人数为6人。有12家机构聘用了离退休人员,社会招聘、自荐及其他途径是社区卫生机构的主要人员来源途径,但近年每年都有人员流失,民营资本社区卫生机构通过自荐途径吸收人才高于非民营资本。非民营机构临床、护理专业人员比例以及培训次数高于民营机构。[结论]应加强对社区卫生服务机构工作的宣传,增加卫生技术人员数量并提高质量,进一步落实人力资源相关政策。     

“和睦模式”建设老百姓如家的医院——杭州和睦医院风采

杭州和睦医院始建于1984年,2004年实行产权制度改革,拥有“杭州市拱墅区和睦街道社区卫生服务中心”和“杭州和睦医院”两套机构名称,成为杭州市第一家以社会民营资本参与的社区卫生服务中心。医院下设社区卫生服务站2个,服务人口2.3万。     

社区卫生服务管理体制面临的挑战分析——基于六城区的抽样调查

目的：分析我国社区卫生服务管理体制面临的挑战。方法：运用焦点组访谈和个人深入访谈的方法收集六城区有关社区卫生服务管理体制的资料,并运用归纳总结的方法对定性资料进行分析。结果：区级政府作为举办主体理顺社区卫生服务管理体制存在困难;各级政府的事权与财力不相适应;卫生部门与其他部门的跨部门合作机制有待加强;社管中心成立的必要性与功能定位仍然悬而未决;如何管理社会资本举办的社区卫生机构有待进一步探索;缺乏居民参与管理的有效途径。建议：理顺政府相关部门之间的关系,促进财力与事权相匹配;建立有效的跨部门合作机制;制定和完善鼓励社会资本发展社区卫生的相关政策;进一步探索成立社管中心的可行性与必要性;探索和完善居民参与管理的有效途径。     

山东省社区卫生服务机构卫生政策执行状况的研究

目的了解山东省社区卫生服务机构执行国家有关卫生政策的现状。方法采用分层随机抽样的方法,在调查中抽取济南、潍坊、聊城三个城市的社区卫生服务中心(站)。结果社区卫生服务机构的举办主体呈现多样化局面;医疗保险需在社区卫生服务中加强实施的力度;进一步推进收支两条线管理的覆盖面;国家基本药品政策能够比较积极执行,以药养医的现象相对缓解。结论政府应对社区卫生服务机构执行国家相关卫生政策的状况进行评估;积极鼓励和引导社会资本举办社区卫生服务机构;推动基本药物制度等政策在社区卫生服务机构落实,全面推广收支两条线,将符合条件的社区卫生服务机构全部纳入医保定点医疗单位。     

民营医院参与社区卫生服务的实践

2004年7月，杭州和睦医院与上海康新集团正式签订了整体转让协议，国有资产完全退出，民营资本注入1000万元，对原有职工进行妥善安置；政府按辖区内服务人口对公共卫生实行经费拨款。和睦医院从此完成了产权制度改革，成为杭州市第一家以社会民营资本参与的社区卫生服务中心。     

中国社区卫生服务的制度选择

中国社区卫生服务经过十余年的发展取得了一定成绩,但是,仍然存在很多问题.政府对社区卫生服务的投入不足,而社区卫生服务自身的筹资渠道又十分有限;以公有制为主的社区卫生服务机构之间缺乏有效竞争,导致效率低下;社区卫生服务的管理机制也不健全.制度安排的不合理正是这些问题的根源所在.相比之下,民营化安排应当成为中国社区卫生服务改革的方向.在民营化安排中,政府作为社区卫生服务的提供者,可以根据不同服务项目的特性选择不同的提供方式,实现规模经济;可以充分利用民间资本,减轻政府负担;还可以引进竞争机制,提高社区卫生服务的效率和对消费者的回应性.     

社区卫生服务综合改革社会满意度调查分析

社会满意度是衡量社区卫生服务中心(以下简称"社区中心")和医务人员诊疗活动结果以及诊疗服务质量的指标之一,日益受到政府部门和卫生管理人员的重视.2007年底,南汇区社区卫生服务管理中心通过委托第三方(上海市质协用户评价中心)对社区中心社会满意度进行了评测.通过测评,进一步了解社区卫生服务综合改革成效,分析影响社区中心社会满意度的因素,掌握社区居民在新时期对社区卫生服务的需求,顺利推进社区卫生服务综合改革.     

我国城市社区卫生服务运行机制的影响因素及对策研究

社区卫生服务是一项利国利民的长期社会系统工程。通过对我国城市社区卫生服务的现状进行分析,探讨了目前我国城市社区卫生服务运行机制以及社区卫生服务运行机制的决定性影响因素,为决策者进一步完善相关政策提供参考。     

三级医院建立社区卫生服务机构的论证分析

社区卫生服务(community health service,CHS)是卫生服务的基础,是提高人民健康水平的重要保障,它追求以最小的社会成本和最便捷的方式来增进居民的健康收益.随着社会经济的发展、医药卫生体制改革的深化和医学观念的转变,社区卫生服务越来越受到政府与社会的高度重视.政府加大了对社区卫生服务的建设,建立了政府主办的社区医疗服务中心(站),同时也允许并鼓励有条件的大中型医疗机构举办社区卫生服务机构.本文通过运用SWOT战略分析方法,了解社区卫生服务机构与三级医院内外环境.探寻三级医院建立社区卫生服务机构的可行性与发展策略.     

Social capital and health care experiences among low-income individuals

Objectives. We examined relationships between social capital and health service measures among low-income individuals and assessed the psychometric properties of a theory-based measure of social capital.Methods. We conducted a statewide telephone survey of 1216 low-income New Mexico residents. Respondents reported on barriers to health care access, use of health care services, satisfaction with care, and quality of provider communication and answered questions focusing on social capital.Results. The social capital measure demonstrated strong psychometric properties. Regression analyses showed that some but not all components of social capital were related to measures of health services; for example, social support was inversely related to barriers to care (odds ratio=0.73; 95% confidence interval=0.59, 0.92).Conclusions. Social capital is a complex concept, with some elements appearing to be related to individuals’ experiences with health services. More research is needed to refine social capital theory and to clarify the contributions of social capital versus structural factors (e.g., insurance coverage and income) to health care experiences.The concept of social capital emerged from work in the social sciences by Putnam and others who defined social capital as what originates from social networks and the reciprocity, trustworthiness, and civic engagement created by these networks.1^–7 Epidemiologists have applied these concepts to public health and have worked to illuminate cause-and-effect relationships.3^,7^,8 At the same time, community interventions and community psychology researchers have used similar concepts of community capacity, sense of community, and community control to explore how to facilitate health status improvements.Researchers have found associations between high levels of community social capital and reduced all-cause mortality rates, better self-rated health, and lower levels of college binge drinking.3^,9^–11 These findings have led to the suggestion that social capital may play a role in mediating the relationship between income inequality and health.3^,4^,8^,12^,13One mechanism by which social capital may influence health, particularly in low-income communities, is its influence on people’s use of health care services. Residents of a community with high social capital may provide one another with greater instrumental and psychosocial support than do residents of a community with low social capital, or the community’s level of interconnectedness and trust may reduce barriers to care. To date, however, little research has examined the relationship of social capital to health service measures such as use of services, participation in care, or satisfaction with services.In one of the few studies to date, community social capital independently predicted the level at which patients trusted physicians.14 In another study, conducted among homeless individuals with mental illness in 18 different communities, associations emerged between community social capital and greater service integration, increased access to housing assistance, and a higher probability of individuals obtaining suitable housing, although an association with clinical outcomes did not appear.15 The few studies conducted, however, leave unanswered the broader question of whether and how social capital is associated with access to, use of, and satisfaction with health services. Also, these studies have not examined the relative contributions of social capital and structural factors such as geographic and financial conditions, which exert important effects on health care access.An additional, methodological difficulty in this field has been the lack of a consistent operationalization of the concept of social capital. Because unique measures of social capital have been applied in most published studies, between-study comparisons remain problematic. Also, the wide variation in measurement approaches makes interpretation of results difficult. Finally, because published studies rarely provide results from psychometric testing of their social capital measures, assessing the validity or reliability of these measures has remained difficult.In this study, we sought to address the need for standard measures of social capital by creating theory-based measures and testing their psychometric properties in a large, statewide sample of low-income individuals. We then used these measures to examine the association between social capital and individuals’ health care experiences.     

Self-rated health and social capital in transitional countries: Multilevel analysis of comparative surveys in Armenia, Azerbaijan, and Georgia

The objective of this study is to analyze the effect of social capital on self-rated health in transitional countries of the South Caucasus region. The study is based on recent, 2009, cross-sectional nationally-representative surveys of 2082 respondents in Armenia, 2014 in Azerbaijan, and 1837 in Georgia with response rate of 78-80%. Two-level random-coefficient ordered logistic regression, modeling individual and community variations in subjective health was estimated to account for the hierarchical structure of the data set which includes individuals nested within communities. The results allow several interesting conclusions to be drawn. First, a proportion of the total variation in self-rated health explained at the community level is 0.23 for Azerbaijan, 0.10 for Georgia, and 0.08 for Armenia. These findings highlight the importance of more decentralized community-based healthcare interventions in the region. Second, human capital covariates remained significant predictors of health status even after controlling for social capital both at individual and community levels. Likewise, social capital variables are significant predictors of health status when used alone and when they are controlled by human capital covariates. These findings suggest that human capital and social capital influence health status independently of each other. Finally, this study sheds light on whether social capital collectively benefits members of a community in transitional countries beyond the individual benefits. In Armenia and Azerbaijan, community level differences in health status are rooted in "compositional" differences between social capital of individuals in the communities rather than at the community "contextual" level. In Georgia, by contrast, the beneficial effect of social capital can be simultaneously observed at the individual "compositional", and community "contextual" levels. These findings suggest that neither "compositional" nor "contextual" models of the social capital effect of health status can apply to all transitional societies universally.     

社会资本与社会医学新发展观

社会资本是近年来广泛应用于政治、经济、社会发展领域的理论,其核心是基于信任的互惠合作网络的建立和对公共事务的自愿参与,以及由此派生出的共同的价值观、行为规范等。将社会资本理论引入社会医学学科,并与社会医学的热点研究领域如社会因素与健康、社区卫生服务发展、新型农村合作医疗筹资、社区开发策略等有机结合,从而为社会医学学科的发展开拓新的思路、注入新的活力。     

Is social capital the key to inequalities in health?

There has been vigorous debate between the "social capital" and "neomaterialist" interpretations of the epidemiological evidence regarding socioeconomic determinants of health. We argue that levels of income inequality, social capital, and health in a community may all be consequences of more macrolevel social and economic processes that influence health across the life course. We discuss the many reasons for the prominence of social capital theory, and the potential drawbacks to making social capital a major focus of social policy. Intervening in communities to increase their levels of social capital may be ineffective, create resentment, and overload community resources, and to take such an approach may be to "blame the victim" at the community level while ignoring the health effects of macrolevel social and economic policies.     

社会资本与农村合作医疗的发展

社会资本是存在于社会结构中的社会规范和社会关系等，具有社会和资本双重特性，对经济增长和社会发展具有明显的外在作用。合作医疗是一种社区筹资，它通过对疾病负担的分摊，保障农村、尤其是农村贫困地区居民的基本卫生服务需求，减缓农民“因病致贫、因病返贫”的发生。社会资本在合作医疗基金的筹集、补偿、卫生服务提供和利用以及合作医疗的监督管理中，具有极为重要且广泛的作用。激活和充分利用社会资本，是合作医疗持续发展的关键之一。     

Social capital, the miniaturisation of community and self-reported global and psychological health

Social capital is often operationalised as social participation in the activities of the formal and informal networks of civil society and/or as generalised trust. Social participation and trust are two aspects of social capital that mutually affect each other, according to the literature. In recent years there has been an increased attention to the fact that generalised trust decreases for every new birth cohort that reaches adulthood in the USA, while social participation may take new forms such as ideologically much narrower single-issue movements that do not enhance trust. The phenomenon has been called "the miniaturisation of community". The effects of similar patterns in Sweden on self-reported health and self-reported psychological health are analysed. The odds ratios of bad self-reported global health are highest in the low-social capital category (low-social participation/low trust), but the miniaturisation of community and low-social participation/high-trust categories also have significantly higher odds ratios than the high-social capital category (high-social participation/high trust). The odds ratios of bad self-reported psychological health are significantly higher in both the low-social capital category and the miniaturisation of community category compared to the high-social capital category, while the low-social participation/high-trust category does not differ from the high-social capital reference group.     

'That's just the cesspool where they dump all the trash': exploring working class men's perceptions and experiences of social capital and health

This article explores issues relating to the concept of social capital which has been become an important explanation for inequalities in health. It is based on an analysis of in-depth interviews with working class men living in two contrasting socio-economic areas--one relatively disadvantaged and one advantaged. It highlights the role of different community contexts in the nature and extent of local social capital. In particular, it demonstrates how de-industrialization and economic change as well as material deprivation and a perceived dis-investment in local communities impacted on the men's levels of social capital. Analysis also shows the ways in which gender mediates the processes through which social capital is developed and accessed as a personal and social resource, and how the norms and values associated with working class masculinities appeared to preclude the men from building supportive health-enhancing relationships with others in their community. The prominence of social capital has focused attention on the subjective dimensions of community life as potential determinants of health. This article has, therefore, sought to contribute to this field by widening our understanding about the relationship between social capital, gender and health.     

Factors enabling community health workers and volunteers to overcome socio-cultural barriers to behaviour change: meta-synthesis using the concept of social capital

Background

Community-based health workers and volunteers are not just low-level health workforce; their effectiveness is also due to their unique relationship with the community and is often attributed to social capital, an area not well studied or acknowledged in the literature.

Methods

A qualitative meta-synthesis was conducted using the SPIDER framework and based on critical interpretive synthesis. The protocol was registered with PROSPERO, ID = CRD42018084130. This article reports on the qualitative data extracted from the final 33 articles selected from 147 full-text articles on social capital and community-based health systems.

Results

Three constructs were identified that enable community health workers to bring about changes in behaviour in the community: seeing their role as a service or a calling motivated by altruistic values, accompanying community members on their journey and the aim of the journey being empowerment rather than health. Community health workers feel under-resourced to provide for expectations from the community, to fulfil their non-health needs, to meet the expectations of their employers and to be able to deliver health services.

Conclusion

The dichotomy of needs between the community and health services can be resolved if policy makers and programme designers examine the possibility of two cadres of community-based health workforce: full-time workers and part-time volunteers, with clear scopes of practice and supervision. Community health workers would primarily be concerned with task shifting roles demanded by programmes, and volunteers can focus on the wider empowerment-based needs of communities.

     

Bonding versus bridging social capital and their associations with self rated health: a multilevel analysis of 40 US communities

STUDY OBJECTIVE: Few studies have distinguished between the effects of different forms of social capital on health. This study distinguished between the health effects of summary measures tapping into the constructs of community bonding and community bridging social capital. DESIGN: A multilevel logistic regression analysis of community bonding and community bridging social capital in relation to individual self rated fair/poor health. SETTING: 40 US communities. PARTICIPANTS: Within community samples of adults (n = 24 835), surveyed by telephone in 2000-2001. MAIN RESULTS: Adjusting for community sociodemographic and socioeconomic composition and community level income and age, the odds ratio of reporting fair or poor health was lower for each 1-standard deviation (SD) higher community bonding social capital (OR = 0.86; 95% = 0.80 to 0.92) and each 1-SD higher community bridging social capital (OR = 0.95; 95% CI = 0.88 to 1.02). The addition of indicators for individual level bonding and bridging social capital and social trust slightly attenuated the associations for community bonding social capital (OR = 0.90, 95% CI = 0.84 to 0.97) and community bridging social capital (OR = 0.96, 95% CI = 0.89 to 1.03). Individual level high formal bonding social capital, trust in members of one's race/ethnicity, and generalised social trust were each significantly and inversely related to fair/poor health. Furthermore, significant cross level interactions of community social capital with individual race/ethnicity were seen, including weaker inverse associations between community bonding social capital and fair/poor health among black persons compared with white persons. CONCLUSIONS: These results suggest modest protective effects of community bonding and community bridging social capital on health. Interventions and policies that leverage community bonding and bridging social capital might serve as means of population health improvement.